Can Global Health Respond to Cultures

While reading about the Sellafield-Windscale sheep farmers in Brian Wynne’s “Misunderstood Misunderstandings” the connection was established between scientific knowledge and tacit knowledge along with the conflict between them that can shape how science intervenes in society. The author’s use of the sheep farmer’s tacit knowledge of the land and the scientists who were unable to be reflexive enough to incorporate that knowledge into their analysis of the ecological behavior demonstrates the “incompatible social and cultural structures” that created the dissidence. Throughout the reading I could not help but wonder what sort of knowledge relationships will emerge in global health and whether or not it will be reflexive enough to incorporate the tacit knowledge of indigenous cultures to which it is applied.

From my perspective, historically in the United States medicine has played an intermediary role between scientific knowledge generation through research and acceptance of new scientific information by the public through knowledge claims. The physician integrates the scientific perspective into something that is capable of dissolving in society and facilitating change. This builds credibility and trust by the community for the physician and offers reflexivity of the personal knowledge of patients for their own health back into their care. However, when speaking of a larger global community perspective and scientific knowledge is being applied to large populations with varying cultures, some with very few physicians to incorporate the much needed reflexivity, there exists a tension similar to the sheep farmers and scientists in Wynne’s article. Different cultures base their identity upon specific characteristics or tacit knowledge that makes them experts in their own environment; whether it is in sheep farming, any farming, pearl diving, factory work or any artifact that communities identify with as individuals. Scientific knowledge has the potential to impose upon the tacit knowledge of the local culture, thus threatening their identity. When a health crisis emerges, protocols established by scientists in the best interest of the society are implemented and it is these steps to provide safety that may fail to recognize the unique cultural needs and information that should be incorporated in the protocol and decision making process.

Furthermore, if scientific knowledge were to overstep bounds there is a regulatory framework established in the United States to allow for deliberation that may alter the function of a particular science and technology. When looking at a global arena, there is global anarchy and with no central governing body there is very little deliberation that allows for input into decision-making regarding global health concerns. While it is true that the World Health Organization incorporates many nations into their system of global health, there can be very little representation of smaller nation states within the larger political network. Furthermore, nations are often required to react to health situations in a manner that reflects a western notion of public health and fails to recognize or legitimate the unique cultural approaches to healthcare that is directly linked to a cultures identity, such as Aryurvedic medicine in India. There can also be very little consideration of the infrastructure of healthcare within certain nations that has recently contributed to a high rate of antibiotic resistant strains of bacteria due to lack of access to full rounds of antibiotics. This lack of access left cultures with partially treated illnesses and created a new situation of resistant bacteria that will be even more difficult to treat, if they can be treated at all. If the global health arena is to enhance public legitimation, knowledge and credibility it may need to incorporate a method for reflexivity that allows for various methods of organizing institutional reforms to accommodate different cultural identities in their solutions.