Editorial Footnotes

Cultural Anthropology has published many articles on global health, including: Ari Samski’s “Scientific Sovereignty: How International Drug Donation Programs Reshape Health, Disease, and the State” (2012); Ramah McKay’s “Afterlives: Humanitarian Histories and Critical Subjects in Mozambique” (2012); and Andrew Lakoff’s “The Generic Biothreat, or, How We Became Unprepared” (2008). Cultural Anthropology has also hosted a podcast interview with Saida Hodžić on “Global Health Governance” (2013).

Additionally, Cultural Anthropology has published articles on "biological subjects", including: Carlo Caduff’s “The Semiotics of Security: Infectious Disease Research and the Biopolitics of Informational Bodies in the United States” (2012); Nancy Campbell and Susan Shaw’s “Incitements to Discourse: Illicit Drugs, Harm Reduction, and the Production of Ethnographic Subjects” (2008); Nancy Scheper-Hughes’ “The Other Who is Also Oneself: Immunological Risk, Danger, and Recognition” (2012).

About the Author

Tobias Rees is an assistant professor of anthropology in the Department of Social Studies of Medicine at McGill University. His expertise lies at the intersection of anthropology, history of science, and the philosophy of modernity. Professor Rees is particularly interested in how categories that order thought/knowledge mutate over time (or differ across space) and in what effects these mutations have on conceptions of the human. Most of his empirical work has been about the neuronal sciences (the recent emergence of a plastic conception of the adult human brain) and global health. In addition, he has written about anthropology after ethnos, that is, about an anthropology concerned with thought and the human-in-motion, rather than with culture and/or society.

Professor Rees is also working on Foreign Moons of Reason, a genealogically organized catalogue raisonné of the effort to study categories of knowledge/thinking (involving anthropology, history of science, and philosophy).

Other Works by the Author

2011. “As if Theory is the only Form of Thinking and Social Theory the only Form of Critique: Thoughts on an Anthropology BST (Beyond Society and Theory),” Dialectical Anthropology 35, no. 3: 341–65.

2011. “Medical Anthropology Enters the 21st Century,” with Allen Young. Journal of Nervous and Mental Disorders 199, no. 8: 592–96.

2010. “To Open up New Spaces of Thought: Anthropology BSC (Beyond Society and Culture).” Journal of the Royal Anthropological Institute 16, no. 1: 158–63.

2010. “Being Neurologically Human Today: Life, Science, and Adult Cerebral Plasticity (An Ethical Analysis).” American Ethnologist 37, no. 1: 150–66.

2008. Designs for an Anthropology of the Contemporary, with Paul Rabinow, George Marcus, and James Faubion. Durham, N.C.: Duke University Press.

2005. “Entwürfe des Perspektivenwechsels. Zur Genese von Fritz Kramers Ethnographiebegriff.” In Schriften zur Ethnologie, edited by Fritz W. Kramer and Tobias Rees, 393–415. Frankfurt/Main: Suhrkamp.

2004. “Anthropos plus Logos. Zum Projekt einer Anthropologie der Vernunft.” In Anthropologie der Vernunft. Studien zu Wissenschaft und Lebensführung, edited by Paul Rabinow, Carlo Caduff, and Tobias Rees, 7–29. Frankfurt/Main: Suhrkamp.

Interview

Stacy Topouzova: In your article, you discuss the efforts of the Global HIV Vaccine Enterprise (the Enterprise) to develop a Scientific Strategic Plan (SSP) to coordinate HIV vaccine research on a global scale into a single experimental system. You describe the agents—practitioners, experts, technicians—as “practitioners of humanity” (461) that define humanity in biological terms. Can you describe the particular contours of biological humanity?

Tobias Rees: When I began working about the Global HIV Vaccine Enterprise, in 2009, I recognized that in the working meetings that would eventually lead up to the SSP the term humanity was used in a somewhat unusual way. What I mean by this is that my interlocutors hardly ever used it as most people would use it, that is, as a plural singular, simply assuming that all humans constitute humanity. Instead they seemed to understand humanity as a project. I was not sure what to make of this observation, not until I by chance overheard Alain Bernstein, Director of the Enterprise until 2012, suggest that the SSP is a plan “for humanity.” It was this sentence that made things fall in place. Precisely insofar as humanity did for my interlocutors not yet exist was in need of a plan: the SSP. This is when I began to begin to think about my interlocutors as “technicians” or “practitioners of humanity.”

A bit later, I became curious about the very concept of “humanity.” When was it first used? By whom? Working through these questions I made two surprising discoveries. First, the concept of humanity, was not known before the eighteenth century. Perhaps one has to pause for a moment to understand what this implies. We so easily speak of humanity, and we tend to think that it is a given. For us the term humanity encompasses all human beings that have lived since the first homo sapiens appeared up until now. One coherent group. However, the general, abstract concept of the human that allows to construct such a group is only a little more than two-hundred-years old. Second, the early authors who wrote about humanity understood their writings as plans, as plans for how to achieve something that does not yet exist: humanity.

I was shocked by these discoveries. Even though I had begun a historical inquiry, I had somehow thought of humanity as a given. Though I was wrong. Humanity is not a given; it is an invention. Humanity is not a timeless object but the product of inventers; that is, of planners, and hence a product that does not exist independently of the plans worked out to achieve it. Provocatively put: no plan, no humanity.

However, I was also excited by the analytical opportunity that the historical contingency of humanity opened up: a comparative history of humanity plans, guided by the question whether or not the humanity plan of the Enterprise amounted to a mutation of what humanity is. When I compared past and present plans, a major difference quickly became obvious: since its first inception in the late eighteenth century, humanity had always been imagined as a family of nations. Planners since the late eighteenth century suggested that the best way to take care of humanity was to establish a plurality of nation states, one for each national society. International health as it emerged with the WHO after World War II was organized by just this idea: the best way to assure the health of humanity was to divide humanity into a discrete sets of nation-states, each one of which would be responsible to foster the health of its society. The object to be worked on, thus, were societies, and health was a social challenge.

Now the SSP radically breaks with the family-of-nations idea and the focus on societies/the social. Neither the Enterprise nor the Gates Foundation or the Institute of Health Metrics and Evaluation (IHME)—my three main sites of fieldwork for the last five years—divide humanity in nations. Rather, they divide humanity into disease-specific populations that run diagonal to nation-states. This has two consequences. One is that what is needed are health care researchers and providers that are independent of nation-states, that can work on this stateless population in a stateless way: hence, the importance of philanthropies, companies, and NGOs. The other is that what is at stake is not a society, that is, a group of people who live on a national territory, who pay taxes, who have a government that is supposed to redistribute taxes and thereby take care of its society. At stake, rather, is a group of biological beings, that is a group of beings who are defined by the risk of getting a particular disease. At stake is a biological, not a social problem.

I wrote about a “biological humanity,” then, because of this contrast between an inter/national conception of humanity and a stateless conception of humanity.

ST: You describe a “global health movement” (466) that has come into emergence since the 1990s, made-up of various organizations and institutions, including the Enterprise, that have “generated” this new form of biological humanity. Who are the foremost actors involved in this new articulation of humanity?

TR: My use of the phrase “global health” is specific. If you take the contrast between international health and global health as I just described it, then I think that “global” health, as it emerged since the late 1990s, is the effort to put into place a global, in the sense of non-national health care and research infrastructure, one that understands humanity in a stateless or global rather than international way, one that understands problems as not confined by national boundaries.

The background story to this emergence of global health, I think, is twofold: On the one hand, there is the terrible effect that the first generation structural adjustment grants of the World Bank had on the national health care infrastructures that were put in place after decolonialization. On the other hand, there is the emergence of AIDS. The World Bank’s effort to privatize health-care services just when AIDS began to spread had tragic consequences. However, to a vast majority of AIDS activists, these consequence became visible only in the mid-1990s, when ARVs became available in the West. At that point, American health activists not only discovered that no one was taking care of the humans in Africa and Asia who were dying of AIDS, but they also observed that governments were not doing anywhere enough to help their societies. And they concluded that what was needed now were new institutions that could address the health problems of humanity in a new, a different way, beyond the reach of nation states. In quick succession, a whole series of new institutions emerged and addressed this need; the most prominent of these were the Global Fund to Fight AIDS, Malaria, and Tuberculosis, the GAVI Alliance, and the Bill and Melinda Gates Foundation. The phrase “global health” emerges in parallel with the emergence of these institutions.

ST: Does this “global biological humanity project” also usher new modes of measurement?

TR: I think so. Take the IHME and its Global Burden of Disease studies, which are organized around DALYs or Disability Adjusted Life Years. Just like the WHO, the IHME collects numbers about the health and disease state of humanity. In contrast to the WHO, however, the IHME does not have to rely on the statistics the ministry of health of a given nation provides. It can also use data from hospitals, from police reports, from insurance companies, and, quite often, from NGOs. Once the IHME has amassed its data, it reconstructs from which diseases humans are dying and thereby reconstruct priority diseases and populations, that often times run diagonal; to national boundaries. Precisely insofar as their data is not coming from and not tailored to nation states, they produce a “global” rather than an “international knowledge” about world health. It is this global knowledge that sets the global health agenda.

ST: You write that the Enterprise opens up new spaces of humanity (469) and it operates on an entirely different logic whereby “one cannot think of humanity in national or societal terms” (470), but what is lost in this space of statelessness?

TR: The obvious answer is: the social. One can react to this loss by way of normative critique: the social is something that should not be lost. If an intellectual approach makes normative critique problematic, insofar as an intellectual approach cannot easily exempt the normative from critical reflection, one has to approach the problem of loss differently. How? Well, one can ask, of what kind is this loss? Where did the thing that is lost come from? What was before? What alternative space of thought, of critique opens up through this loss? Helpful for my own efforts to think through these questions were the works of Hannah Arendt and Michel Foucault.

In his lecture, “Society Must be Defended,” Foucault outlined how, in the late eighteenth century a new conception of politics emerged, one that suggested that politics is a battle between “societies” or “nations,” both new concepts at the time, that were understood as a physiologically, racially coherent group of people. Foucault then shows that the French Revolution was ultimately a race war, that is, a war between three societies/races/nations that claimed to be the people of France. After the Gaul, in a genocidal act, eliminated the other two peoples, the Franks and the Romans, they alone were “the people of France.” After the French Revolution, with the emergence of the nation-state, political existence was at stake in biological existence. Foucault concluded, and that must have been outrageous to many of his peers, that everyone who understands himself or herself as social activist or a social critique was somehow, well, a racist. Precisely insofar as the term society was, as a political and anthropological concept, historically contingent on the emergence of the nation-state as composed of one race. He was serious, I think. For he concludes his lectures with the question of how, today, one can be a critical thinker interested in politics without being a racist, that is, without framing ones thinking in social/societal terms?

Arendt’s critique of the social unfolded along similar lines. She knew from experience, as a Jew in Nazi Germany, as friend of Walter Benjamin and many others that were killed, that those excluded from the society/race that claimed to be constitutive of the state, were also excluded from political rights. I think that all of her books can be read as an effort to think about the human and politics in terms beyond the social/societal.

Now, if one takes serious, with Foucault, that the concept of society, or the very idea that humans are social beings did not exist before the eighteenth century, then this opens up a before as well as an after: if there were vast stretches of time when the concepts of society and the social did not exist, when humans were hence not social, then there might as well be instances of an after, that is, instances in the here and now that escape the logic of the roughly two-hundred-and-fifty-year-old concept of society/the social. And if one takes serious Foucault’s and Arendt’s efforts to open up possibilities of thinking the human and politics without the concepts of society/the social, then the challenge of a critical anthropology of thought is not to denounce the loss of the social/society as an animalization of the human but rather to calmly and critically outline why, in which ways, global health escapes these concepts and why, and in which sense, this is an opportunity to rethink our critical vocabulary and to invent through research a new political science of the human. This is a massive challenge for all social sciences, not just for anthropology. After all, the legitimacy of the social sciences grounds in the presupposition that humans always were and always will be social/societal beings.

Supplemental Resources

The Bill and Melinda Gates Foundation Global Health Initiatives

The Global Burden of Disease 2010 study

Global HIV Vaccine Enterprise

Scientific Strategic Plan

The Institute for Health Metrics and Evaluation

Michel Foucault Archives

Hannah Arendt Papers at National Congress

Supplemental Readings

Biehl, João. 2007. Will to Live: AIDS Therapies and the Politics of Survival. Princeton, N.J.: Princeton University Press.

Fassin, Didier. 2009. "Another Politics of Life is Possible." Theory, Culture & Society 26, no. 5: 5–46.

Redfield, Peter. 2008. "A Less Modest Witness." American Ethnologist 33, no. 1: 3–26.

Ticktin, Miriam, and Ilana Feldman, eds. 2010. In the Name of Humanity: The Government of Threat and Care. Durham, N.C.: Duke University Press.