Control, Cure, and Prevention: Situating Global Response to Tuberculosis in San Diego County
- Author(s): Friedman Aytes, Laurel H.
- Advisor(s): Goldfarb, Brian
- et al.
There are many stories of tuberculosis: of its causes and consequences, of social injustices, of public health reform, and of the communities, individuals and families impacted by the disease. By considering the multifaceted narratives of tuberculosis, this research aims to develop a better understanding of how representations of the disease are connected with their materializations across global and local contexts. My mixed-methods research combines an ethnographic study of the Tuberculosis Control and Refugee Health Program at San Diego County's Public Health Department; analysis of contemporary media; and historical research on public health debates and policy related tuberculosis control locally, regionally and globally.
In my dissertation, I examine the frictions between regional public health efforts and universally mandated protocols that define the problem of tuberculosis and the solutions to its control. A central focus of this project is an interrogation of normative culture and expectations for cure by shifting focus away from the micropractices of illness prevention that are implicated in the regulation of non-normative, othered bodies. Looking at misfits between globally defined public health regimes and local clinical public heath practice, my research questions the logic of the current model of "cure as prevention" with its focus on [non]compliant individuals, including how this focus sidelines consideration of the aspects of the disease and its containment that are socially produced or that vary across cultural and geographic place.
Investigating the various boundary positions of tuberculosis helps articulate the kinds of negotiations involved in enacting control programs, while reimagining tuberculosis control as a communicative space brings to life the ways that struggles over meaning reflect struggles over the maintenance of power. If dominant discourses of health and cure reinforce the bounds of the abject by positioning the disease as a conundrum of the problem body, reimagining tuberculosis control as a communicative space pushes at the rough edges of normative representation.