Privatization and the New Medical Pluralism is the first collection of its kind to explore the contemporary terrain of healthcare in Guatemala through reflective ethnography. This volume offers a nuanced portrait of the effects of healthcare privatization for indigenous Maya people, who have historically endured numerous disparities in health and healthcare access. The collection provides an updated understanding of medical pluralism, which concerns not only the tensions and exchanges between ethnomedicine and biomedicine that have historically shaped Maya people’s experiences of health, but also the multiple competing biomedical institutions that have emerged in a highly privatized, market-driven environment of care. The contributors examine the macro-structural and micro-level implications of the proliferation of non-governmental organizations, private fee-for-service clinics, and new pharmaceuticals against the backdrop of a deteriorating public health system. In this environment, health seekers encounter new challenges and opportunities, relationships between the public, private, and civil sectors transform, and new forms of inequality in access to healthcare abound. This volume connects these themes to critical studies of global and public health, exposing the strictures and apertures of healthcare privatization for marginalized populations in Guatemala.

In most places on the African continent, multiple health care options exist and patients draw on a therapeutic continuum that ranges from traditional medicine and religious healing to the latest in biomedical technology. The ethnographically based essays in this volume highlight African ways of perceiving sickness, making sense of and treating suffering, and thinking about health care to reveal the range and practice of everyday medicine in Africa through historical, political, and economic contexts.

An unsettling exploration of the hidden power dynamics of global health, seen through the lens of childhood diarrhea and its treatment within the Guatemalan context. 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.

This contributed volume explores flexible, adaptable, and sustainable solutions to the shockingly high costs of birth across the globe. It presents innovative and collaborative maternity care practices and policies that are intersectional, human rights-based, transdisciplinary, science-driven, and community-based. Each chapter describes participatory and midwifery-oriented care that helps improve maternal and newborn outcomes within minoritized populations. The featured case studies respond to resource constraints and inequities of access by transforming relations between providers and families or by creating more egalitarian relations among diverse providers such as midwives, obstetricians, and nurses that minimize inefficient hierarchies within maternity care. The authors build on a growing awareness that quality and respectful midwifery care has lower costs and improved outcomes for child bearers, newborns, and providers. Topics include: Sustainable collaborations including transfers of care among midwives and obstetricians in India, The Netherlands, Germany, United Kingdom, and Denmark Midwifery-oriented, femifocal, indigenous, and inclusive models of care that counter obstetric violence and gender stereotypes in Mexico, Chile, Guatemala, Argentina, and India Doula care and midwifery care for women of color, previously incarcerated women, indigenous women, and other minoritized groups in the global north and south Practices and metrics for improving quality of newborn and maternal care as well as maternal and newborn outcomes in disruptive times and disaster settings Sustainable Birth in Disruptive Times is an essential and timely resource for providers, policy makers, students, and activists with interests in maternity care, midwifery, medical anthropology, maternal health, newborn health, obstetrics, childbirth, medicine, and global health in disruptive times.

Markets, not politics, are driving health care reform in America today. Inventive entrepreneurs have transformed medicine over the past ten years, and no end to this period of rapid change is in sight. Consumer anxieties over managed care are mounting, and medical costs are again soaring. Meanwhile, the federal government remains mostly on the health policy sidelines, as it has since the collapse of the Clinton administration's campaign for health care reform. This book addresses the changes that the market has wrought- and the challenges this transformation poses for courts and regulators. The law that governs the medical marketplace is an incomplete, overlapping patchwork, conceived mainly without medical care specifically in mind. The ensuing confusion and incoherence are a central theme of this book. Fragmentation of health care lawmaking has foreclosed coordinated, system-wide policy responses, and lack of national consensus on many of the central questions in health care policy has translated into legal contradiction and bitter controversy. Written by leading commentators on American health law and policy, this book examines the widely-perceived failings of managed care and the law's relationship to them. Some of the contributors treat law as a cause of trouble; others emphasize the law's potential and limits as a corrective tool when the market disappoints. The first two chapters present contrasting overviews of how the doctrines and decision-makers that constitute health law work together, for better or worse, to constrain the medical marketplace. The next six chapters address particular market developments and regulatory dilemmas. These include the power of state versus federal government in the health sphere, conflict between insureres and patients and providers over medical need, financial rewards to physicians for frugal practice, the role of antitrust law in the organization of health care provision and financing, the future of public hospitals, and the place of investor-owned versus non-profit institutions. Acknowledging the health sphere's complexities, the authors seek remedies that fit this country's legal, political, and cultural constraints and can contribute to reasoned regulatory goverance. Within limits they believe a measure of rationality is possible.

A woman with hypertension refuses vegetables. A man with diabetes adds iron-fortified sugar to his coffee. As death rates from heart attacks, strokes, and diabetes in Latin America escalate, global health interventions increasingly emphasize nutrition, exercise, and weight loss—but much goes awry as ideas move from policy boardrooms and clinics into everyday life. Based on years of intensive fieldwork, The Weight of Obesity offers poignant stories of how obesity is lived and experienced by Guatemalans who have recently found their diets—and their bodies—radically transformed. Anthropologist Emily Yates-Doerr challenges the widespread view that health can be measured in calories and pounds, offering an innovative understanding of what it means to be healthy in postcolonial Latin America. Through vivid descriptions of how people reject global standards and embrace fatness as desirable, this book interferes with contemporary biomedicine, adding depth to how we theorize structural violence. It is essential reading for anyone who cares about the politics of healthy eating.

The concept of “Waithood” was developed by political scientist Diane Singerman to describe the expanding period of time between adolescence and full adulthood as young people wait to secure steady employment and marry. The contributors to this volume employ the waithood concept as a frame for richly detailed ethnographic studies of “youth in waiting” from a variety of world areas, including the Middle East Africa, Asia, Europe, Latin America and the U.S, revealing that whether voluntary or involuntary, the phenomenon of youth waithood necessitates a recognition of new gender and family roles.