On Deconstructing the Discourse

March 9, 2007 at 9:54 am (AE Beacon's Posts)

“Can one divide human reality, as indeed human reality seems to be genuinely divided, into clearly different cultures, histories, traditions, societies, even races, and survive the consequences humanely? … For such divisions are generalities whose use historically and actually have been to press the importance of the distinction between some men and some other men, usually towards not especially admirable ends.”

-Edward Said in Orientalism  


The central mission of Global and International Health is to improve health conditions for people facing the highest burden of disease and suffering. This lot typically falls to those living in Africa, Asia and South America. However, is the discourse of this benevolent mission categorically reinforcing the social order it seeks to alleviate?

What is the utility of the phrase “developing country”? The original conception of developing versus developed countries was created as an economic method of stratifying nations by economic output. Despite having limited correlations to health status, this terminology has been subsequently adopted by health workers to define areas of supposed greater disease burden and suffering.

This transliteration fails to achieve several of its objectives. First, lumping countries into developing or developed ignores the spectrum of need between nations. Second, nation based classifications of health fail to accurately represent the internal needs of political groups such as immigrants or internally displaced persons and social groups such as religious and ethnic factions or women and children. Finally, some developing countries such as Cuba, despite having the resources and political structure that would otherwise suggest poor health, have managed to produce impressive health outcomes. Thus, the concept of developing country does not accurately evaluate how well a region or nation can deal with its health issues.

The segregation of developing and developed nations does succeed in accomplishing several things. First, it insists on the immaturity of developing countries. Inherent to this distinction is the idea that developed countries have achieved a universally attainable state of happiness and prosperity, a socio political nirvana if you will, through integrity, hard work and ingenuity. Implicitly, that developing countries have failed to reach this standard reflects more on their inadequacy than on divisive social and economic structures that keep them in poverty and disarray.

Second, this construct asserts that the methodologies of my society, capitalism and cultural exportation, are requisites of domestic success.  Despite the considerably dependence of my economy on cheap goods from elsewhere, we have maintained an equal opportunity rhetoric that doesn’t suffice to describe our domestic state let alone global economic and political involvement. Finally, the concept of “developing” demeans the intelligence, talent and efforts of (health) professionals abroad. Stripped of the comprehensive diagnostic testing equipment, auxiliary support staff and myriad pharmacological interventions would our physicians be more capable? I won’t posit an answer but only suggest that poor outcomes reflect more than the physician’s capability.

So what can we change? How can we (I) more accurately delineate differences in health outcomes without disparaging those in need?

Æ Beacon


1 Comment

  1. msoule said,

    I really dig your analysis. It’s comprehensive and edgy and raises a lot of really good issues. I especially like what you said about “developing” as a word and how it demeans those in poor (post-colonial, present-exploited) countries and also makes it seem like those in “developed” countries have It All Figured Out.
    I’d like to underline the fact that we do NOT have It All Figured Out. As the paper I posted earlier about measuring neighborhood health outcomes in Chicago points out, lumping groups in “developed” countries together ignores the particular outcomes of poor communities within those countries. For instance, it is well known (to those who ask and look) that the health of people living in Harlem is far worse than people living in other parts of Manhattan. If we look at the health outcomes of New York City, they are quite good. If we separate the neighborhoods, it becomes clear that our work is far from done.
    It is for this reason that I have been posting about the poor in America. We forget about them because of the shocking poverty in other countries. We of the “developed world” still have much to do to equalize things in our own homes. By working and studying abroad, we can get the tools to do so in any setting but we need to remember that we still have work to do around here.
    And I’d like to propose using the language of poverty when talking about countries and places that have fewer resources. I understand that it can be difficult to say it outright, but it might be the best. “Underserved” might also be okay. I think this conversation about language is really important.

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