Underbelly

Childhood Diarrhea and the Hidden Local Realities of Global Health

Rachel Hall-Clifford

• Publisher: The MIT Press
• Year: 2024
• eBook ISBN: 9780262378291
• Edition: 0
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

Deaths from childhood diarrhea seem preposterous in high-income countries. Yet, for children under five years old in the rest of the world, diarrhea is the third highest cause of mortality. Despite a glut of prevention and treatment programming spanning more than forty years, this least glamorous of global health ills remains a critical problem. In Underbelly, Rachel Hall-Clifford takes a hard look at the pathways of global health funding and development policies and the outcomes they deliver for recipient individuals and communities. Drawing on fifteen years of ethnographic research in highland Guatemala, Hall-Clifford focuses on the provision of primary health care services as a critical exemplar of how global health and development programs fall short.

Guatemala has a fragmented health system, the author explains, that guarantees health as a human right but also suffers from systemic racism, inadequate health services and access to those services, community distrust from a legacy of harm and violence, and a demeaning paternalism. Bringing together the discourses of global health and medical anthropology, Underbelly explores the ways in which global health—its actors, structures, and systems—perpetuates the challenges it purports to fix: this is the underbelly. Hall-Clifford argues that global health programs, conceived in offices distant from the places in which they are delivered, often have unintended consequences and contribute to pluralistic and exclusionary health systems that mirror neoliberal economies. She argues that if we are to fix this entrenched crisis of health inequity, we must use the immense resources of global health to center local communities as drivers of change.

With a foreword written by Waleska López Canu, an Indigenous Maya medical director, and an afterword by Arthur Kleinman, renowned expert in global health, this book underscores the importance of looking deeper into what seems on its surface incontrovertibly "good" to understand the more complex realities on the ground and in people's lives.

Table of contents

• Cover
• Title Page
• Copyright
• Dedication
• Contents
• List of Figures and Tables
• Acknowledgments
• Foreword
• Prologue
• Introduction
• 1. Oral Rehydration Therapy and the Not-So-Simple Solution to Diarrhea
• 2. Entanglements of Empowerment: Women, Caregiving, and Global Health
• 3. Of Machetes and Medicine: Troubled Pathways to Government Health Services
• 4. Turning Diarrhea into Dinero: Market-Driven Health Services
• 5. Global Guidelines, Local Realities: Complexities of Global Health
• Conclusion
• Afterword
• Index