10 thoughts on “Please respond to the readings on CCA on the Ground here!

  1. Entertainment education appears to have been a hot-strategy for western interests to communicate their objectives in subaltern communities. Ironic on its own is the premium put on the idea of entertainment and the entertainment industry as a space where true, behavior changing communication campaigns can live. How do you not think about the role of reality television in the U.S. as an avenue for behavior change, intended/unintended, desired/undesirable? The Dr. Phils and Ozes of the world dole out non-evidence-based strategies to change the behaviors of individuals and, more importantly, creating opportunities for ad revenues during commercial breaks.

    In this regard, one could use Dr. Phil as the hegemonic actor, hosting a bad-acting teen mom who “just won’t say no”, forcing on her the idea that family planning can and must be practiced, effectively and emotionally sterilizing the show’s guest without really getting to the root of the root for what this young woman, and millions of other young women who experience unplanned teen pregnancies may be looking for and identifying as a need. Hence, the importance of the participatory approach to health communications and behavior change in individuals and populations.

    One gaping problem with the Dr. Phils and UAIDs of the world is that their objectives both seem to come down to money, and not helping people identify their own agency as a marginalized person/people within a respectful and honoring dialogic space. Follow the money for objectives of USAID, where their goal, ultimately, is for sustained economic growth and social development to begin in these subaltern communities and, eventually, to economically flourish as investments with high potential yields on ROI. You could argue that Dr. Phil’s objective is to make as much money as possible selling his brand, pushing his capitalism-of-the-entertainment-psychologist and where the “subaltern” guests’ long-term health is never cycled back in or revisited. Never before has there been a link between high commercial ad revenues and the mental health of Dr. Phil’s guests, similar to UASID’s economic growth desires linking to healthy population behavior changes. The interrogation of this and other reality TV powers that prey on marginalized people to drive ad money streams has never occurred.

    Can you imagine if we didn’t pay attention to the sometimes-secret sterilizations of black women in south Africa just because we trusted the hegemonic powers that dictated the world didn’t need more black babies in south Africa, but needs to incentivize white babies being conceived? This is why it is monumentally important to ensure that the participatory approach doesn’t just sell the agenda of the campaign designer because the projects will only dangerously further Western hegemony’s interests and never truly honor what subaltern classes say when we as public health professionals have the moral fortitude to ask open-ended questions and listen without judgment or predestined agenda. We all deserve agency, especially when we feel like basic needs aren’t even being met. I can’t wait to learn more about participatory practices that involve and value, above all, the voices of marginalized people(s) when the public health community works in step and not on-top of identifying problems and articulating solutions.

  2. There are several issues that Dutta (2009) addressed around Entertainment education (E-E) campaigns that I agree with – largely that the campaigns exclude the voices of the community and that the developers come in with their agenda already set. I especially appreciated the critique of the funding sources – namely USAID. Dutta outlines succinctly the “covert purpose” of USAID – that of insuring the continual opening of markets for US corporations to invest in. This arrangement continues the imperialist project of underdevelopment that in turn causes disastrous effects on people’s health and environments. Dutta exposes the contradiction within USAID – an agency meant to better people’s health yet also protects transnational capitalism that destroys the livelihoods of people.

    Where I question Dutta (and something I am still trying to figure out) is in Dutta’s articulation of the subaltern, specifically in the places in which he cites Gayatri Chakravorty Spivak, who wrote the essay “Can the Subaltern Speak?” (1988). This essay by Spivak, from what I understand, is often misread and here is no exception. Dutta in several parts of the essay talks about how the dominant E-E silences the subaltern voices and emphasizes that solutions to health problems need to be “including the voices of marginalized people” – however, Spivak concludes in her essay that the answer to her question – Can the SubAltern Speak? is No – in fact, one of the last lines of her essay is “The subaltern cannot speak.” Spivak also talks about the subaltern as a predicament – not an identity – and cautions people not to generalize the subaltern. Subalternity is not about “Empowering” the marginalized voices (a word that Dutta uses a number of times in the paper) – in fact, Spivak wants the eradication of the subaltern and that once they escape from the silence of the subaltern they are no longer the subaltern. Spivak for me is difficult to read and I also am still working out my own thoughts around subalternity – but this paper by Dutta helped me understand what she was saying. She says that we can not access the subaltern – (and says neither can she..) – that the positions we occupy (like Dutta) still obscure the subaltern.

    Dutta seems to suggest that researchers need to be in dialogue with communities in “defining and articulating” solutions – yet I would question some of this. They already know – and it is clear in the few quotes that he uses. All of them speak to their poverty and lack of food – these “alternative articulations” as he describes are not clouded in obscurity – rather it is very clear to those suffering. He also says that future scholars need to “locate the agency of subaltern people” – implying they have no agency, yet human history tells a different story of people that have long fought for humane conditions and their very survival without the help of researchers. Dutta has some good critiques here but he needs to go further in his articulation – his answers lie in having “dialogue with elite classes to facilitate structural change “ (this is reform language); “reallocation of resources” and “redistributive justice” – which he does not define and I do not understand what that means. Elite classes will not hand over power with some dialogue and make serious structural change, that is pretty clear (Reforms and individual rights here and there, sure..). He earlier attacks transnational capitalism but should keep going with it. The “structure” he mentions – is capitalism in my understanding – although he should define what “structure means. Reallocation of resources within capitalism does not change the “structure” – it tries to make a kinder capitalism – however the very mechanism of capitalism necessitates the existence of poverty (Dutta says it in other word – “poverty is created.”) – you cannot be wealthy without making others poor in this economic system.

  3. Dutta’s focus on justice and the covert, capitalist, elitist status quo maintaining intention of E-E campaigns was direct and refreshing. Reading a well articulated, clear, thoughtful dressing down of mainstream public health organizations lit a fire of hope in my belly. Maybe it is possible to acquire funding for projects that are truly centered in the needs of the community, that give voice to people who are consistently marginalized, used and spat out by the capitalist, white supremacist bourgeoisie that rule the world markets. Seeing the practices of international ‘aid’ organizations laid out so explicitly is especially sickening. The linkages made between US economic growth, expansion of the market in the developing world, and structural focus on population control is sinister. We peel back the layers of propaganda and find, in every sector of capitalist market and world governance, greed, power-mongering, and something close to evil.

    It’s easy to get lost in the philosophical morass of theories, models, expected outcomes and data findings. The heart of public health, in my opinion, is about shared humanity, the commitment to the fundamental human right to health and access to all that entails. Although this article is rather more wordy and academic than it needs to be, it has human beings at it’s core. We need more of that in this field.

    While Dutta’s values seem human-centered and anti-capitalist, and in essence ask researchers to co-create projects with those who are being impacted rather than come in with the problem and solution already decided, some of the language he uses doesn’t work for me. I still don’t feel completely comfortable with the concept and frequent use of the word ‘subaltern’. I understand the temptation to define, and more precisely articulate categories of people, but also feel that action in itself to be somewhat problematic. It continues to reinforce boxes and assumptions about wide swaths of people, in this case people whose voices are not heard in the very arena where the word that defines them is used. I would like to understand the word ‘subaltern’ more, as well as why people feel it is useful.

  4. I had a hard time wrapping my head around the language and writing style of this article, as I do well with direct language and clear examples/case studies. I also feel not entirely equipped to critique it, as I don’t know enough about international development priorities and the historical nuances that were referenced. One quote that stood out to me was “For the subaltern participants, health is located in the structural inequities that produce poverty.” (p. 229). I think that this is very true, and goes to the heart of the point, but it is necessarily at odds with the USAID goals of population control? Also, in terms of funding agencies it was mostly USAID that was critiqued, but what about the WHO, World Bank, certain UN agencies, the Gates Foundation, and others? Does some of this same critique apply?

    This article also made me reflect upon my own perspectives on population control, as I typically see the chance to give women control of their reproductive decisions a really positive thing and a great equalizer. Another thing that I was thinking about while reading this – is social media a potential tool to raise subaltern voices? I was wondering about that as it may be more easily participated in by some people.

    I agree with Mira’s point above about the term “subaltern.” I have not read the other essay referenced and that Anna discussed above, and this was a new term for me, so again I’m not sure that I feel full equipped to understand it. I felt that more case studies/examples in this article talking about who exactly this consists of in a variety of societies, and how a better public health communications campaign would look like would be useful.

  5. The article by Dutta introduces interesting points about HIV/AIDS and the Indian trucking population. There was a lot of discussion in the article about interventions targeting this population. Some of the discussion included “there have been a multitude of initiatives targeting them both from the government entities who interact with them” (p. 258) and
    “ ‘Avahan’ was conceived as a focused prevention program that targeted high-risk groups and bridge populations in the most affected areas of India with a known package of prevention interventions” (p. 258).

    However, it was frustrating to read all of that and not have any specific examples of interventions that were enforced on the population. What were the HIV/AIDS prevention programs? How were they implemented? Were they effective? How did the truckers respond to these interventions? Thus, I would have personally liked to read specific case studies regarding these prevention programs which would have helped me better understand the role of Avahan and the prevention services it provided.

  6. There honestly was a lot to process here. In addition to learning new, more ethical, more effective participatory-based methods, and community engagement practices via class discussions, we have also learned what NOT to do. As such, I found these chapters to be a good tool on how to analyze and critique “philanthropic” organizations, media, and subversive messages that are disseminated. As my dad would say, it is important to find out ‘what they’re selling’.

    As other people have noted, many organizations go into other countries and cultures promising economic growth, social mobility, and technological development only to strip people of their resources for profit. One of my anthropology professors once mentioned how the World Bank (or a related organization) created a nutritional crisis in Peru. If I remember correctly quinoa became wildly popular in America and Europe. The farming population in Peru normally had small subsistence practices, so they would only produce and sell enough for their families. Investors caught wind of this and paid a lot of money for the local population to start growing and selling quinoa en masse saying that this would create jobs, make money, and create new opportunities for their communities. While economic growth looked promising, farmers were paid very little for their crops and soon couldn’t afford the marked-up quinoa they grew, as it was shipped overseas. Instead, cheap, nutritionally deficient white rice (produced and sold by the US) was all that they could afford. As the quinoa that was a part of a traditional, nutritious diet, was now gone, the population got very sick. One other example that comes to mind was of WHO drawing blood from people in a small community in West Africa who had Ebola (if I remember correctly it was from children who did not survive the disease and passed shortly after the blood draw), without informed consent and without treatment. As a result, the people in these communities very understandably didn’t trust WHO healthcare workers, and the virus continued to devastate the area (Dancing Skeletons outlined this case briefly, and I highly recommend it to anyone in public health). They could have actually asked the people in these regions where they thought the virus came from, but they didn’t until anthropologists were brought in. In short, as others have mentioned, many outside forces that come into other cultures don’t always have a history of “helping” so much as using that guise to steal or use the situation to benefit themselves in some form. Additionally, up until very recently, people haven’t even bothered to listen to and give agency to the experts, the people who are a part of the community that is effected. Hence why I felt compelled to go into public health, as I saw it start to utilize more medical and applied anthropological based approaches .

    I’ve come to realize that E-E campaigns are everywhere. They are used to portray societal values, how they can be perceived, and how they can be measured. Most often these values are dictated by groups in power, and often don’t reflect reality and the perspectives of anyone who isn’t a part of this very small demographic. As a result, when E-E campaigns do not consult or are not made by the people who are impacted, they can be incorrect and, at worst, harmful. Thus they not only spread misinformation, but also stereotyping and the perpetuation discriminatory views. What’s more, since it is so prevalent that even when non-explicit (although becoming more glaringly explicit as the semester continues and I learn to spot it) media is used to shape how certain groups of people are viewed based on ethnicity, religion, sexual orientation, sex, and gender. Thus, these messages are acted out through audience behavior and impact marginalized groups, sociocultural and political environments, as well as research. Hence why representation in media and E-E campaigns are so important. When people who have lived experiences and identities create messages, that are not misconstrued by groups in power, these can return agency to people in these groups, help to re-shape how of marginalized groups are viewed in a culture, and can help break the cycle of misrepresentation and misinformation.

  7. Dutta’s article on Avahan program reminds me of family planning programs in Bangladesh. Low literacy rates, cultural stigmas prevented rural as well as a lot of educated urban people to talk about family planning. Specially women didn’t have much access to knowledge about family planning and contraception. Even a few years back it was kind of an unilateral decision of the male in the family whether to use contraceptive methods. Programs implemented over the last couple of decades have changed this picture. Community programs aimed to reach females in a house were developed. For a specified rural area, few influential women/ community leaders had been picked and had been trained by the Union Health & Family Welfare Centers in that area to reach out to the female. The trained women went from house to house or even arranged social gathering to convene female audience and talk about family planning. The trained workers educated them and influenced them to talk to their male partners about family planning and contraception. Women who faced difficulty in influencing their male partner shared their experiences and based on that the outreach programs were modified. Use of contraceptives increased about 35% since the nineties. To me, the effort was successful because of community participation, education, outreach and empowerment of actual users of contraceptives.

  8. Overall, I really appreciated this article and seeing some further context to Dutta’s approach in Communicating Health and the Culture Centered approach.

    I agree with Anna, Mira, and Lishai, that the use of the term ‘subaltern,’ particularly through the introduction portion of the reading, sat oddly with me. I am not familiar with the article Dutta cited which Anna discussed; but I do agree with her assertions about what ‘subaltern’ communities know and do not know—and the problematic implications within the notion that their agency must be “located.” Indeed, that phrasing seems out of alignment with Dutta’s writing in The Culture Centered Approach, where he argues for “privileging the voice of the subaltern.” Maybe this slight difference in tone and approach was a refinement of thinking between the time this article was published in 2006 and Communicating Health, published in 2008. Also—I wonder that this difference in wording is nuanced to the point that in raising it I am here engaging in some frivolous neoliberal problematizing that we so much enjoy in academic spaces? But I think the implications of the differences between “locating” a persons voice versus “privileging” it are significant enough to point out and consider, for my own learning if nothing else.

    It is unsurprising, though frustrating, to see examples of USAID using locating its investment in foreign E-E entirely in relation to US security priorities. At first reading, I was especially disgusted with the quotes from USAID directly naming motivations for health programming in marginalized countries to American security and future opportunities for profitable markets for American businesses; but on second consideration, I have read deliverables from USAID and met people who have worked for them—I do believe there are *at least* individuals working at USAID who are morally and ethically committed to improving the wellbeing of the marginalized. I wonder how different some of these quotations are from the language you might see in the significance section of almost every funded NIH grant proposal—which many researchers I know shape to appease the official priorities of the institution, even though awarded funding might not be spent with those exactly articulated priorities in mind? I would be interested in the class’s thoughts on this.

    Dutta’s example of the participatory work by JHU/PCS in Nepal is a great narrative to describes how, despite the apparent intention of working alongside the community, ultimately the power of decision-making is almost automatically defaulted to the dominant academic and governmental institutions involved. This is an extremely common problem which I have seen and read about across many kinds of community engaged research, including Community Based Participatory Research, (CBPR) Action Research, (AR), and Participatory Action Research, (PAR). One clear reason for this common issue is simply the top-down, patriarchal structure of the academy as we know it. In my personal experience, this top-down context not only demands this approach which centers Western hegemony in each individual project—but the overall structure of the academy and how it is funded even trains emerging scholars from the very beginning of their work to conceptualize projects in this oppressive way! It takes serious commitment to a process of unlearning to truly move away from this approach while operating from within the very structure that perpetuates it. While the text goes on to describe several participatory projects which successfully center the subaltern, I would like to hear more about the specific relationship building that was done between the academics involved, their funding agencies, and their community partners.

    The remaining examples highlight the importance of the subaltern voice through many examples of successful community-led attempts to address alternative problems that have great impact on community health. The point that subaltern voices and approaches are absolutely vital to the wellbeing of people in their own communities is made so well, I am truly left wondering, what is the point of Western/academic approaches to these problems? If the goal is “speaking from below,” and we see that communities raising up to advocate for their own health issues, on their own terms, is demonstrably more successful in a concrete and material way for these communities—why do Western funded E.E. campaigns at all? Dutta points to the usefulness of meaning making and capacity building between Western academics/interventionists and the subaltern, but what exactly is the use there? Are us Western academics bringing anything useful to the table besides economic resources?

  9. I agree with what some of my classmates have already said around the language in the article, specifically “subaltern.” I would argue that the use of the term can do the opposite of what Dutta is proposing in the article. I think in highlighting the subaltern voice means communicating oppression directly. So those that are “oppressed” have an oppressor. Those that are marginalized are being marginalized by someone. It seems like the language attempts to protect people but inadvertently does the opposite because it doesn’t put the onus on the correct person. I don’t think this article is quite as refine as his last one, but that makes sense as this one was written prior to that.

  10. I personally really liked the article that we were assigned . The language was a bit difficult for me to understand, and I agree with a lot of the comments made about how it’s a bit indirect, but I really liked it overall. I really liked the part in the article where the author talked about how with the spread of HIV/AIDS we often seem to forget the “narratives of structural violence and material inequalities underlying the disease. The stigma with HIV/AIDS can be often very toxic- people are often insulted, excluded socially, and rejected by their community.
    I also loved the part where the article talked about the formative research, participation, and co-operation of local agency. I enjoyed how they talked about how the Avahan trucker project is the first Indian national program to successfully us active truckers along with former truckers as peers to reach the truckers was such a great idea. It’s such a a great community based approach, and it can be very empowering for both the truckers and the former truckers to be part of this. They mentioned that it’s a dialogue-based interpersonal communication approach and it’s also a great way to employ ex-truckers. I just think that this is such a great approach, and by hiring the ex-truckers you’re benefiting the community and you are not putting money into hiring outsiders.

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