Cultural politics of disease control: State-community relations in the struggles against malaria in the Philippines.

摘要

This dissertation addresses the dynamics of domination, conformity, and resistance in the struggles against malaria involving the state health functionaries and an Ilokano community in northeastern Luzon, Philippines, in the early 1990s. It analyzes these dynamics in terms of the concept of cultural politics, defined as the encounters of power-laden cultural schemas taking place in contestations over definitions of and responses to social reality at a given time.; Using historical records, this study describes the key features of the schema of malaria control espoused by the state. The analysis shows that the schema upholds a well-entrenched epidemiological orientation, adheres to a top-down health policy formulation and implementation, champions the rhetoric of "malaria blocks economic development," and depends heavily on financial and technical assistance from international health and development agencies.; Using surveys, interviews, and participant observation, this inquiry analyzes the Ilokanos' cultural understandings of the body, health, sickness, and healing. In practice, these understandings indicate the rootedness of the physical presentations of sickness such as malaria in the social and moral spheres of daily experience. Moreover, these understandings have resulted in the reconfiguration at the local level of the definitions of malaria, including the global antimalarial strategies such as spraying of houses with insecticides, treatment of bed nets with pesticides, environmental engineering, case finding and treatment, and community participation.; Grounded in asymmetrical power relations, the encounters between the state health functionaries and the Ilokanos reflect the contradictions between the state schema of malaria control and the Ilokano ethnomedical knowledge and practices. These contradictions contribute to the persistence of local apathy, ambivalence, and resistance towards the official antimalarial strategies.; This study of the cultural politics of the state-community relations in the arena of disease control aims to contribute to the current discourse on the inseparability of culture, power, and history.