Discursive and Practical Challenges in Global Health: Pesticide- Related Health Impacts in Ecuadorian Banana Production
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DISCURSIVE AND PRACTICAL CHALLENGES IN GLOBAL HEALTH: PESTICIDE- RELATED HEALTH IMPACTS IN ECUADORIAN BANANA PRODUCTION by BENJAMIN WESLEY BRISBOIS B.Sc. McGill University, 2001 M.E.S. York University, 2006 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES (Healthcare and Epidemiology) THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) October 2014 © Benjamin Wesley Brisbois, 2014 Abstract This dissertation aims to inform more equitable and effective practice in the emerging field of global health. To address this overriding question of how principles of equity and effectiveness can best be implemented, I critically analyze discursive and practical challenges facing Northern researchers as they approach health problems in the global South, and explore solutions to these challenges. This exploration employs a case study on the articulation of a specific problem in a specific, nominally ‘Southern’, setting: pesticide- related health effects in Ecuador's banana-producing El Oro province. I employ three methodological approaches, in three substantive chapters. Chapter 2 uses discourse analysis to understand how Latin American research sites are framed in peer-reviewed pesticide epidemiology articles. These articles often employ geographic representations of Latin America as inexplicably underdeveloped to demonstrate the need for pesticide research and health sector interventions, typically exhibiting ‘mainstream’ (Northern) public health institutional dynamics. I also show how some epidemiologists are pursuing more politically engaged approaches, in an uneasy negotiation with epidemiology's disciplinary norms. Chapter 3 reports on ethnographic pesticide risk perception work in El Oro, drawing on theories from anthropology and human geography. I document how pesticide risk perception narratives reflect El Oro's position in unstable global commodity chains. Scalar elements of these narratives combine individual and structural explanations for health problems in complex ways. In Chapter 4, I describe a political ecology of health explanation of pesticide exposure in El Oro. I employ a modified meta-narrative methodology, complemented by ii ethnographic fieldwork, to synthesize literature relevant to the pathways – biological, political economic, environmental and cultural – leading to pesticide-related impacts in El Oro. This analysis complements Chapters 2 and 3 in making the case for empowerment- based participatory approaches to pesticide exposure problems (and, by extension, to global health more generally), with special attention to international linkages, environmental complexity and political economy. The introduction, conclusion and 'linking' material between chapters serve to enhance the coherence of the dissertation by providing additional material not appropriate for inclusion in the three chapters, including elements of reflexivity. iii Preface The research for this dissertation was carried out within a partnership linking universities in Canada and Ecuador to address environmental health issues. The partnership, under the leadership of Drs. Jerry Spiegel and Annalee Yassi in Canada, and Dr. Jaime Breilh in Ecuador, began in 2004 with funding from the Canadian International Development Agency to initiate a Masters Program in Public Health with an Ecosystem Approach (Parkes et al., 2009; Spiegel et al., 2011). I conceived the research described in this dissertation to complement and build on research done by students and researchers involved in studying pesticide-health issues in Ecuador in connection with this Masters program. Building on the CIDA-funded work, a research program has undertaken more recently to address the health effects of the global food system in Canada and Ecuador, funded through a Canadian Institutes of Health Research (CIHR) grant to Dr. Jerry Spiegel. This CIHR-funded research program is entitled Think, Eat and Grow Green Globally (TEG3), and I designed my research – in collaboration with Dr. Spiegel, my supervisor – to inform its ongoing development, especially an epidemiology study within it focusing on pesticides and health in Ecuadorian banana production. In addition, I contributed to the design and grant proposal for TEG3, especially a project within it employing a modification of Greenhalgh et al.’s (2005) meta-narrative synthesis methodology. Chapter 4 of this dissertation employs this methodology, the development of which drew on discussions between Dr. Spiegel, other TEG3 co-investigators, and me. My remaining committee members also obviously contributed to the design of the research reported on in this dissertation through informal iv discussions and by reviewing and giving feedback on my dissertation proposal. I independently carried out all data collection and analysis myself. Chapter 2 has been published [Brisbois BW (2014) Epidemiology and ‘developing countries’: Writing pesticides, poverty and political engagement in Latin America. Social Studies of Science, 44(4), 600-624. doi:10.1177/0306312714523514]. This journal is published by Sage. I carried out all of the analysis for this paper, and wrote the manuscript myself. Drs. Jerry Spiegel, Leila Harris and Peter Cramer helped me to conceive the methodology for the paper, and provided comments on a draft version prior to its publication (in addition to the journal’s anonymous reviewers). The research reported on in this dissertation was approved by UBC’s Behavioural Research Ethics Board, under Certificate #H11-01427 for the project entitled ‘Pesticides, bananas and health’. v Table of contents Abstract ..................................................................................................................................... ii Preface ..................................................................................................................................... iv Table of contents ...................................................................................................................... vi List of tables ............................................................................................................................ ix List of figures ............................................................................................................................ x List of abbreviations ................................................................................................................ xi Chapter 1: Introduction ............................................................................................................. 1 1.1 Global health and political power .......................................................................................... 1 1.2 Discursive dimensions of global health ................................................................................. 5 1.3 Practical challenges in global health .................................................................................... 10 1.4 Case study: Pesticide exposure in Ecuador’s banana-producing El Oro province ............... 11 1.5 Methodology and dissertation structure ............................................................................... 18 1.5.1 Chapter 2: Epidemiology and ‘developing countries’: Writing pesticides, poverty and political engagement in Latin America ........................................................................................ 20 1.5.2 Chapter 3: 'A question of culture': Pesticides and health in the banana capital of the world…… .................................................................................................................................... 22 1.5.3 Chapter 4: Bananas, pesticides and the political ecology of health on Ecuador’s southern coast: A modified meta-narrative approach to targeting research and interventions in global health ................................................................................................................................. 25 1.5.4 Between-chapter material ............................................................................................. 27 1.6 Reflexivity ............................................................................................................................ 27 1.6.1 Student life ................................................................................................................... 28 1.6.2 About the author ........................................................................................................... 30 Chapter 2: Epidemiology and ‘developing countries’: Writing pesticides, poverty and political engagement in Latin America ................................................................................... 37 2.1 Introduction .......................................................................................................................... 37 2.2 Methodology ........................................................................................................................ 40 vi 2.2.1 Frame analysis (quantitative sample) ........................................................................... 40 2.2.2 Sensitivity analysis: Disciplinary conventions and writing choices in the mixed sample ………… ...................................................................................................................................... 43 2.3 Results .................................................................................................................................