The Socio-Political and Cultural Determinants of Diarrheal Disease in the Mekong Delta

Abstract

The annual diarrhoea deaths of children under 5 years old in the world are at the striking level of 1 - 3 million. Together with pneumonia, diarrhoea is one of the primary killers of children and especially the poor, with countries in Africa and South East Asia (SEA) bearing most of its global burden. Vietnam is a country which, despite its official exit from poverty during the 1990s, has been facing an average of over 1.5 million annual documented cases of diarrhoea for the period between 2005 and 2011. This high incidence of the disease persists despite the existence of known preventions, and thus remains an ongoing development concern. By examining the case of diarrheal disease in the region of Vietnam's Mekong Delta, the study strives to understand the factors that govern this essentially preventable health risk. The goal of this study is particularly to answer how cultural, social and political environments define and shape the spread of diarrheal disease in Can Tho City in Vietnam's Mekong Delta. <br /> In order to achieve this goal, the study draws greatly from the theoretical current of Political Ecology. Tracing the roots of inequalities that come together with the use of natural resources, political ecologists usually seek to answer how knowledge around these risks is being constructed. Through this questioning of socio-environmental problems, power emerges as an element which determines if and how policy will be turned into practice and whom this process will benefit. Similarly, as this study aims at locating ‘the political’ in disease, it asks questions such as: what guides the spread of disease physically, what hinders its control institutionally and why people are disempowered from being able to be adequately protected from it. Engaging with questions of how the risk of disease is constructed, communicated and understood, this study, therefore, also calls for a better understanding of the agents who produce, receive and circulate that knowledge. The field of Critical Medical Anthropology proves extremely useful in exploring human health in this regard, laying bare issues of access to wealth and power, relating health patterns to socio-political aspects and to the cultural meanings that are ascribed to disease. <br /> In the case of Vietnam, it was shown how the projected image of a modernized and developed state which procures for its citizens highly contradicts the reality of a degrading and increasingly unhealthy environment, with significant parts of the population being vulnerable and suffering from a disease that can be controlled. This now obvious contradiction, however, remains blurred within the country. The constructed discourse marginalises the poor and normalises suffering, while at the same time legitimising the state's abdication of its responsibility to provide basic healthcare and clean water; instead the state transfers these responsibilities to the people. The Vietnamese state has subtly, but methodically, designed its institutions in a way that they obey bureaucratic order and present proof of their prescribed activities; even if in reality, much of the policy is hardly ever turned into meaningful practice. As this study shows, even though indicators of disease (incidence and mortality) provide a measurable and logical way to assess health risks, this type of assessment defines the risk of disease in a very narrow manner. It is for this reason that biomedical experts, public health practitioners and international think-tanks on health need to engage in a sincere dialogue with the humanities, including ethnographers, sociologists and political scientists. Although the methodologies and the epistemologies followed in these widely-defined fields might diverge immensely, they share a common interest of acting for the improvement of human health. If such a claim holds truth, then there is a lot to be gained from interdisciplinary thinking and sharing.