Liberalizing, Feminizing and Popularizing Health Communications in Asia

Liew Kai Khiun

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9780754678397
• eBook ISBN: 9781317105398
• Edition: 1
• Topic: Scienze sociali
• Subtopic: Antropologia

Liberalizing, Feminizing and Popularizing Health Communications in Asia provides insights into the manner in which biomedical discourses are communicated and portrayed in Asia in light of the rapidly evolving socio-cultural, technological and epidemiological undercurrents. Highlighting the more pluralized and interactive dynamics in the appropriation and dissemination of medical and public health knowledge, its specific case studies challenge the notions of the one way transmission of medicine by modern Western trained doctors and public health officials to ignorant patients and masses, particularly in the non-Western world. With specific examples drawn from popular media, this volume examines the extent to which these developments have given the broader public both greater access to information and choices. Multidisciplinary in scope and truly international in focus, it relates the everyday of health communications to more macro social trends on the Asian continent and will be of interest to scholars within science and technology studies, media and cultural studies and sociology alike.

PART I
Liberalizing Health

Chapter 1
Mediations of Health and the Development of a Nation: Late Suharto, Late Modernity

Steve Ferzacca

As Suharto’s regime of 38 years was nearing its end in the mid-1990s, political commentary and critique were becoming expectedly common. The traditional sources of political dissent, the youth, and in particular students, along with producers of expressive cultures, conjoined with other politically motivated elements to defy President Suharto’s hegemony. Most observers have cited the 1997 Asian economic crisis as the main impetus for destabilizing the status quo, and in turn, facilitating the rise of the Reformasi movement (Reform) that marked Suharto’s downfall. Predictably, as the economic crisis in the region took hold in Indonesia, students and other youth groups (pemuda) were seen to be leading the way in effecting social change in Indonesia. This is Indonesia in the past tense of regime change as it was taking place in the present tense once again.

In the early nineties (1991–93), before Reformasi, I was conducting anthropological fieldwork in the central Javanese city of Yogyakarta on the pluralistic character of medical practice in this urban milieu. My focus was on medicine and its organization as a socially, culturally, and historically charged response to what is often referred to in the international health literature, and as I was to find, in Indonesian context as well, as diseases of development. Type 2 diabetes is just one of several health conditions that are included is this disease profile that has been variously labeled in this traveling theory on the relationships between health, society, and behavior as diseases of development, affluence, civilization, or simply as “Western” diseases. I was interested in the kinds of local discourses and practices that surround such health conditions in a country simultaneously labeled and self-consciously referred to as Third World, traditional and developing, yet also and one which was self-consciously believed to be on the road of progress (maju). In Indonesia at the time, the media and public health institutions mostly commonly used the phrase, penyakit gaya hidup, or lifestyle diseases, often adding the term barat, or western, at the end for good measure when referring to this particular health portfolio.

This chapter considers the presence of the media at the twilight of the Suharto regime in a long-standing cultural politics founded upon the centrality of national development known as pembangunan that was crucial for state governance, but also for the imagined community that is Indonesia. Pembangunan, and especially Indonesia’s homespun version of this historical process has been inscribed in so many ways as this nation’s destiny. The Suharto regime can easily be characterized as one designed and engineered by an ideology of “developmentalism” (Heryanto 2005). The pembangunan state emplaced the nation-state itself as a key chronicle for highlighting the successes of a historically anchored yet generally agreed upon process of development. The promise envisioned “rapid economic growth” and “increases in overall prosperity,” while downplaying increases “in relative impoverishment, and the strengthening of the state apparatus vis-à-vis the emasculation of alternate political structures” (Hatley 1994: 216).1 Pembangunan was (and is) also crucial for understanding the emerging concerns with lifestyle diseases commonly associated with the syndromes of modernity. As we will see, medical experts of all kinds were deeply involved in this discursive project, and as I’ve argued elsewhere (Ferzacca 2002), this lived governance.

Health and media, with its emphasis on the structurally supported cultural ideal of pembangunan has ironically played a significant role in the demise of Suharto’s New Order regime. This proposition is counterintuitive, given accepted wisdom on the subject of President Suharto’s fall from power after more than three decades of dictatorial control in this archipelago of some 250 million people. Analyses of Suharto’s political demise generally point to growing media and public dissatisfaction fed by the removal of government subsidies on gasoline prices, cooking oil and other daily necessities as the regime attempted to respond to the pressures of the Asian financial crisis in 1997. Conventional wisdom has also identified youth and student groups, as well as other equally recognizable cultural circuits responsible for the sustained agitation and moral critique of officialdom in Indonesia. Health practitioners and the health professions, formal and informal, are not often considered as part of this circuit, at least in Indonesia. However I argue, it was precisely these “schooled” experts (Anderson 1991: 119) who were perhaps unwittingly, nurturing in the media a publicly sensed “affective register” (Irvine 1990), a “cultural anxiety” (Kirmayer, Young, and Hayton 1995) that played some part in regime change.

Media and health share a double-voiced relationship especially, but not only, in the context of the state. All forms of political organization generate this double-voiced quality in the relationship between health and any mediated manner in which health is the central organizing motif of communicability (see: Briggs 2005). Health information is precisely that—information about health, illness, health care provisions, and so forth that ostensibly people need in order to make informed decisions. The media, through oral traditions, print, electronic, and so forth, are vehicles for conveying these messages publicly and privately. In any case, mediated health information is never just about its delivery. In fact, it is an undeniably ideologically prescriptive based upon shared understandings of normality and abnormality. This is precisely the double-voiced quality that haunts the relationship between health related messages; a relationship moored to prevailing and evolving social structural arrangements, historical forces, cultural energies—everything needed to live experience the human way. This study then continues a long-standing anthropological tradition in interpreting the communicative aspects of society (Levi-Strauss 1963: 83), which expanded into the area of medical humanities, includes both the structural practices as well as their articulations through the media.

In order to exact this cultural psychology from disparate sources—health and media—some relationship needs to be identified, or at the very least inferred as conditional. It is one thing to argue that until these social and financial eruptions, Suharto’s control over the realpolitik, but more importantly, the “work of the imagination” (Appadurai 1996) that was and is in Indonesia, remained, for the most part, unquestioned. A long-standing method for political control by the regime has been through the media (Agassi 1969; Jackson and Pye 1980; Kitley 2001). Even before Indonesian Independence from Dutch colonial rule, “a new fixity to language” (Anderson 1991: 44), the use of Malay, through mediations in the emerging mass media was “central to the subjective idea of the nation” (ibid). And so, states talk or are at least made to talk, and the media has been the central medium through which states speak. Corrigan and Sayer (1985: 3) argue the speech acts of states are “statements” that “define in great detail, identities and practices that are deemed acceptable; they regulate, in empirically specific ways, much—very much by the twentieth century—of social life. Indeed, in this sense ‘the State’ never stops talking.”

Corrigan and Sayer, as well as a multitude of others, emphasize the “orality” of the state in the shaping of social life. Scott (1998) however places importance on the ways in which states see in order to conscribe fields of vision into recognizable literacies for power. Newberry (2006), following Elias (1994), Bourdieu (1977), Comaroff (1985) in other contexts, emphasize the livedness of state rule in the Indonesian context. These various metaphorical renderings and “gross actualities” (Geertz 1973) of state power and rule—in sum—connote an all-over “sensual world” (Stoller 1989) of the state. This is exactly the relationship between the media and health, as state-making and state-undoing projects that I am suggesting to explore and argue for in this analysis. A rather old idea, the body politic of the state in this sense is an organized vitality as Durkheim (1972: 192) suggested when he metaphorically rendered the state as an “inner organ… at the center of a particular kind of consciousness,” circumscribed, deliberate, and conscious of intent. The perceptual prowess of the state, then, is multifaceted, as is any experience of and with it. Empirically this is precisely the manner of the rule the Indonesian state had in mind and in body, and analytically this is precisely the vantage point from which we need to begin in order to establish a role public health media had in regime change.

At the twilight of Suharto’s New Order government, the sensual world of Indonesian state rule was organized by the desire to progress and develop. Reality and dream were consciously combined in and around state activity and national ideology in Suharto’s plans (Replita) for the negara pembangunan, or developmental state. At the time of my fieldwork during the years 1991 to 1993, the sensual world of Indonesian modernity was diagnosed and the prognosis was “good”, as the country was thought to be experiencing the predictable symptoms of progress. Public health, with its experts and expert systems, brought other histories into the conscious experience of Indonesian citizens, who were already aware that not all was well with the Indonesian body politic.

In the following I will briefly outline the significance of the health of modernity for state rule near the end of Suharto’s regime. Central to the statements on the health of modernity and vitality of development, was the health risk of adopting a western lifestyle, or gaya hidup barat; a lifestyle thoroughly modern and metropolitan. Professional concern with the health of modernity emerged as a vibrant public critique of the essentiality of development (pembangunan) as the future and destiny of the Indonesian people and nation state. The orderly progression of the developmental state under Suharto was abruptly blocked by the events that led to the demise of his regime and the rise of reform. Since then, the Reform Movement (Reformasi) dominant motifs concerned with the health of modernity have shifted from progressive movement towards either caring for a “sick nation” (Rais 1999, The Independent 2001, Siebert 2002), or a “sustainable future” already in place but in need of protection from deterioration.

The State of the Media in Indonesia

A look back at the role of the press just before Suharto came into power illustrates the limits and possibilities of the “freedoms” of expression in the dawn of this newly established nation-state that persisted until the nightfall of the New Order regime. A closely monitored press is a common thread that is woven through the regimes of Sukarno and Suharto. Agassi (1969) identifies the use of several “ideological and political concepts” by the Indonesian government before, during, and after the regime change from Sukarno’s Old Order to Suharto’s New Order following the 1965 “failed coup.” Sukarno’s Five Pillars (Pancasila), Agassi (ibid: 207) found, had “deeper root in the thought and emotions of the Indonesian people than any of the other parts of Sukarno’s Indonesian philosophy.” She argues that in the media “Pancasila” was used “as a general yardstick for morality of political behavior” (ibid: 208), as well as a “yardstick for proper internal governmental and party political arrangements” (ibid: 209). In 1964, before the failed coup, an editorial in the Indonesian newspaper, Duta Masjarakat remarks that “Pantjasila is our basis and guide in how to be a complete revolutionary” (ibid: 211).

In contrast, the Indonesian media characterized Suharto’s New Order as: “sobriety, efficiency, technical and economic skill, the rentability of economic projects, realistic prices, balanced budgets, and an international stance in harmony with Indonesia’s real economic capability” (Agassi 1969: 221). In his inaugural address on 27 March 1968, Suharto announced, “With the adoption of the Five Year Development Plan, Indonesia’s New Order has entered a new chapter called the Development Chapter.” Makarim (1978: 259), former chief editor of an Indonesian newspaper, wrote of the changing media climate in Order Baru’s Indonesia as a “close-government-press relations” entailing a “from a preoccupation with ‘national prestige and national identity’ during the period of ‘Guided Democracy’, to one concerned with clean and efficient governance for economic growth”. Philip Kitley (2001: 261) describes the “media function” during Suharto’s New Order regime based on the assumption that media is powerful in its effects and therefore in need of control. Such controls, as Barbara Hatley (1994: 246) notes, creates “dominant trends” that are largely “anti-realist, ahistorical, apolitical tendencies hardened into a restrictive orthodoxy.”

Strassler (2000: 72) in an examination of political communications post-Suharto compares this “moment of opened possibility” to signify “new opportunities for political expression bumped up against enduring structures of exclusion.” Kitley (2001) with another before-after the Suharto regime comparison characterized as “after the bans” only serves to highlight the extent of the authority of the Indonesia state in the mass media at the time. The Indonesian mediascape during the Suharto regime can generally be characterized as bans, repression, control, and surveillance in the name of “guided media development” (Kitley 2001: 256), a perverted view of national security, and the centrifugal circulation of New Order renditions of Indonesian cultural values and identity.

The sociological composition central to the “looming so overwhelmingly large” (Marakim 1978: 279) positioning of the Indonesian government in the media at the time was organized around an elitist network that nurtured a “culturally conditioned network of subtle gestures and signals.” Overt surveillance and control of mass media content existed along with much “self-censorship and compliance with official directives” (Kitley 2001: 262, Marakim 1978). Civilian experts, or technocrats, began filling the ranks of Suharto’s administrative machine (Sidel 1998, Winters 1996, Mackie and MacIntyre 1994: 11) along with military personnel (ABRI), private businesses and financiers, relatives, to some extent political parties, and other Indonesia elite formed the jaringan (network) of the New Order’s administrative and bureaucratic power (Sidel 1998; Schwarz 1994...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• List of Figures and Tables
• Notes on Contributors
• Acknowledgements
• Introduction
• PART I LIBERALIZING HEALTH
• PART II FEMINIZING HEALTH
• PART III POPULARIZING HEALTH
• Index