2011 Presentations (Communicative Events)

Illness, Marginalization, and Global Health Interventions in Post-Soviet Eurasia

Koch, Erin

Throughout Eurasia and Central Asia contemporary health care reforms emphasize privatization of medical services and insurance. As free-market ideologies and practices take on local forms and meanings, states continue to withdraw social services and safety nets. Most depend on international aid and NGOs for health system support. For many health care providers and patients, these transformations exacerbate health inequalities and marginalization. This paper provides an anthropological analysis of the health effects of displacement, and of global health and humanitarian aid in the Republic of Georgia. I utilize ethnographic research among Internally Displaced Persons (IDPs) who have been displaced since the 1992-1993 Georgian-Abkhaz civil war. International aid organizations and local NGOs working with IDPs monitor health status, and facilitate and impede access to medical and other social services. Foreign assistance directives influence these humanitarian and state-supported health policies, about which IDPs are not provided sufficient information, aggravating their mistrust of the government and relief organizations. The paper examines the meanings and effects of changing health care policies for IDPs and NGO workers. The anthropological approach shows that health assistance programs constitute moral economies in which discourses about "individual responsibility," "national success," and "humanitarian service" shape and affect intervention and continued investment. The paper also discusses the broader implications of the Georgian case for understanding effects of shifting state responsibilities on population health and medical service availability, and the significance of anthropological insights about health inequalities and marginalization for global health policy and humanitarian interventions in the region.