States, Bodies, and Epidemics

What is an epidemic?

The first couple of critical essays we read in this class (after having read the Camus novel) are two classic articles by Charles Rosenberg, “Explaining Epidemics” (1992) and “What Is An Epidemic? AIDS in Historical Perspective” (1989). These two essays laid out a social theory of epidemics that still holds sway for many scholars in medical anthropology and in the history of medicine fields.

In the essay “What is an epidemic?,” Rosenberg proposes that epidemics can be ‘read’ like plays–that is, that their development can be understood to follow a certain dramatic arc. The three stages he proposes are 1) the “progressive revelation” of the presence of disease, 2) the management of “randomness” as a characteristic of epidemics, and finally 3) the negotiation of a “public response” to the disease.

You may be able to relate or apply this tripartite model to the current pandemic of novel coronavirus (COVID-19), as well as other epidemics. Look, for example, at the graphic below, developed by Prof. Mark Nichter that shows the phases of the 2009 Influenza pandemic.

In the essay “Explaining Epidemics,” Rosenberg discusses the different theories of disease causation that have been used over time to explain the origin of disease. He proposes the framework of “configuration” and “contamination” as the two main approaches. He closes the essay stating that, “these perspectives represent emphases, not answers–elements in a complex discourse about human-kind, fate, and social organization that is never answered, but only reconfigured by each new generation.” I discuss in more detail the relationship between these two theories of disease causation in the video below.

Here is a video I recorded responding to student questions and comments on these two essays. Please share your responses in the comments below!

By Adriana Garriga-López

Associate Professor of Anthropology at Kalamazoo College

10 replies on “What is an epidemic?”

The relationship between configuration and contamination, as well as predisposition had me thinking about the politics of epidemics. Rosenburg’s emphasis on the impact of public policy reaffirmed this connection. I began to think about environmental racism and many of the articles we’ve read off the Facebook page about how COVID-19 is disproportionately harming marginalized peoples. This is not because they’re naturally more at risk, but because of deliberate political action that places PoC in particular into positions that make the risk of infection greater (mass incarceration, redlining, etc.). The interconnected nature of policies based on racism and classicism are being highlighted due to this pandemic. The solution of “just stay in your house” doesn’t apply to people that don’t have homes, have essential jobs, or can’t afford to stock up on enough resources to stay put for an indefinite amount of time.

P.S. I don’t know why my avatar is a One Direction picture from 2013 but it won’t let me change it so I guess my middle school directioner phase will live on.

Madeline, thanks for your comment. I am glad you are thinking about the politics of epidemics because that is exactly what I am hoping for! Yes, as you can see, the pathogen is the same for everyone (SARS CoV-2) but the effects are not the same for everyone. If you take only the contamination view, we only see the pathogen, but if we look at the configuration perspective, we can see that the pathogen interacts with all manner of social phenomena (including racism, sexism, and anti-immigrant discrimination) to produce particularly deadly results among oppressed people. Keep thinking in this way!

When I think of the “configuration” and “contamination” emphases in public health, I think of the example of HIV/AIDS prevention and treatment in East Africa and specifically in the lake region of Kenya. In terms of a “configuration” approach, many NGO’s in the region have centered their focus onto income generation (vocational training in high-demand fields like hair styling and hospitality) and childcare (so that people can generate income without worrying about their kids) for prevention. These seem almost tangential to disease, especially to a disease like AIDS which is transmitted via sex and other “fluid-transferring” behaviors like IV drug use, not money and family. But as Rosenberg lays out in his essay, configuration pertains to the material circumstances of life, which can include money and family. As it pertains to the situation in the Lake region of Kenya, women who cant generate an independent income are stuck between a rock and a hard place because they need to support themselves, thus resorting to sex work. And this sex work isn’t negotiated or unionized, it’s an attempt to make ends meet. People in this situation do not have the negotiating power for condoms and then this is where the contamination emphasis comes in. As AMGL said in the video, condom negotiation is important for the prevention of HIV and other STD’s because it provides a barrier like latex to prevent contamination and viral spread. The approach in this region is better than most approaches to HIV I’ve seen elsewhere and I’d like to continue talking about it if y’all want, but I don’t want to bore you all in the comment section of this blog post.

Thank you for sharing!!! There’s a similar story being told in Thailand but they also had a super big campaign to push the use of condoms (Captain Condom). It was successful in lowering the birth rate (to the point where there are hardly any students our age in Thailand) but the narrative wasn’t pushed in an HIV or STD prevention scope. I think it is really interesting how people address Sex Work and reproductive health so I really appreciate the example!

Everyone’s comments are so helpful and I learnt so much!
As I am thinking about the configuration and contamination, I am understanding the significance of configuration’s role in (bacteriological, viral) contamination. But I was also thinking about how the current government of India is creating discourses by using the configuration view in order to blame muslim communities for contamination (of the virus) to marginalize them even further especially with the Ramazan going on. The government is espousing islamophobia by using the pseudo/imagined configuration (as the IT cell of the government circulates fake videos of Muslims meeting each-other, or spreading news about how consuming meat can pass the virus) to blaming them for the contamination (which is also fake). But I am not sure this if I am giving a right example, because I think Rosenberg’s theory is more productive? And my example is embedded more in religion based discrimination. I thought of this example because I was thinking about Singer’s “biosocial” framework and how a theory can either create different meanings depending the time and space but also the people who are employing it.

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