About Me

My career thus far has been spent in the guts of global health NGOs, within activist collectives getting arrested and marching in the street, around seminar tables debating the meaning of ‘violence’, and in classrooms with bright-eyed undergraduate students seeking to make sense and a difference in a dying world.

This work has calibrated my empirical attention to the disconnects and convergences between local experience and global representation. Just as the phenomenology of suffering and locally held illness experience is different from the professional representations and diagnostic criteria of disease definition; so too is moral experience, the lived values most at stake within the networks of human relationships that make up the local world, distinct from the academic discipline of ethics: the technical-professional justificatory discourses made and circulated within elite institutions. What connects these realities? How can we reconcile these often-discordant rationalities?

Global health problems are powerful strategic sites of ethics-informed sociological research because they combine concerns that have been historically central to sociology: the making and use of scientific knowledge to justify social practice; decisions about the allocation of scarce resources by states and other delivery institutions; and the moral and political concerns about how to deal with widespread social suffering. Analyzing global health problems also forces the reevaluation of provincially European, North American, and methodologically nationalist research. After nearly 15 years of working in global health organizations and activities, I have focused my own attention and research most specifically on the field- based symbolic and material struggles that shape global health practice. I am particularly interested in sites of anomalous practices and successful resistance; how global health organizations develop alternative strategies in advancing state-protected universal health care access, social change, and human rights. Such research can develop better understanding of the social processes that shape the convergence (or violent collision) between what is considered good, moral, just, a matter of fact, or a practical necessity in the abstract and at a distance, and the existentially felt and locally experienced suffering produced by a global material playing field wildly askew.

The Dissertation

My dissertation comparatively explores the work of two significant “public health demonstration projects,” one in the Global North and the other in the Global South, along the lines of material setting, discourse, and science-making practices. My argument links the micro-level practices of particular public health scientist practitioners, to their meso-level institutional orders, to the macro-level struggles in global health that ultimately orient their work. Differences in epistemic practices reveal how post-colonial power and politics are enacted and reproduced through public health science. The dissertation engages with a foundational puzzle: Why are non-communicable diseases (NCDs) near the bottom of the list in terms of global health funding and political priority when together they account for the most death and suffering globally, particularly amongst the world’s poorest populations?

I engage this puzzle by analyzing the work and impact of two model public health programs, one which succeeded in making legible the problem of NCDs as understood and experienced by citizens in the Global North in Finland and one which is challenging that understanding, based on the experiences of the poor in the Global South in Sierra Leone. The North Karelia Project, launched in eastern Finland in the early 1970s, generated science and practice that was taken up by the World Health Organization (WHO) and has become hegemonic, dominating global NCD public health discourse and rendering understandings of alternative causes and potential interventions invisible. The integrated NCD clinic at Koidu Government Hospital is the first clinical program to treat ongoing chronic illnesses—an issue that is frequently assumed to be too expensive for poor governments to address—in post-conflict and post- Ebola Sierra Leone, which hosts one of the weakest health systems in the world but which is part of a broader movement to challenge the dominant WHO NCD policy. Drawing on theories from medical sociology, science and technology studies, and global and transnational sociology, I use this comparison to explore how and why some understandings of NCDs prevail and why others fail and to gain leverage on three important related questions: (1) How are depictions of the burden of NCDs and their severity constructed in different material and social settings? (2) How do those depictions become stabilized (or not) in the global discourse about global health priorities? And, (3) What are the implications of such contrasting stabilization processes?

I find that public health scientific actors work pragmatically—constantly caught up in a web of competing local practical material interests, extra-local competing moral concerns, and networks of intermediary institutions that shape the problems that rise to the surface of their cognitive attention and social problem framing. These incommensurable concerns, tensions, values, and interests shape a hierarchy of “sociological ambivalences” that must be sorted, prioritized, ignored, or conceptually erased: in a word, they must be quelled. The tactics mobilized to quell the sociological ambivalences experienced by public health scientist-practitioners depends on the material (physical arrangements of material infrastructure) and institutional resources (norms, rules, organizational forms) at hand: the tactics are social epistemologies representing locally pragmatic solutions to problems of knowledge and institutional order. But, when only held locally, these social epistemologies hold little value beyond their local instantiations; to become valuable beyond the local – that is, to truly become science – they must be assembled into immutable mobile models that can be communicated, taught, transmitted, and circulated. These immutable mobile models take the form of research articles, pictures, graphs and diagrams, accounts, PowerPoint presentations, books, lectures, popular news stories, etc.

Simply constructing these immutable mobile models, however, is not sufficient to ensure that the locally stabilized knowledge – quelled ambivalences and all – make it into global circulation. At the meso/institutional level, immutable mobile models must represent strategically valuable “hinges” – conceptual tools that “work” in multiple homologous fields of struggle at once – if they are to really travel. In this way, the search for strategic sites of public health scientific demonstration and practice (not unlike the work by bench scientists to assemble strategic material arrangements within laboratories capable of stabilizing particular kinds of scientific facts capable of traveling beyond their walls) is as much about the concrete local health problems of individuals and populations as it is about a researcher’s attention to the possibility of constructing an extra-locally valuable hinge. When successful, hinges can be converted into field-specific “capital” that can be used by public health scientific practitioners to gain entrée into more prestigious discursive and scientific spaces, to be converted into financial or economic capital, or to capture more political power over the realm of policy governance.

Other Research

Beyond the dissertation, I have solo-authored and worked collaboratively to publish several other pieces closely related to the sociological interests outlined above. In 2021, I published a piece in Sociology Compass titled, “Knowledge, boundaries, and bodies: Social construction between medical sociology and science and technology studies” that traces the important contributions that social constructionist research has made at the interstices of medical sociology and STS, further clarifying the history, points of intersection, and areas of diversion between them. Also in 2021, I published a piece in Third World Quarterly with my coauthor Benjamin Hunter titled, “Human capital, risk and the World Bank’s reintermediation in global development” which analyzes a new effort at the World Bank, the Human Capital Initiative (HCI). The HCI is the Bank’s response to its own institutional sidelining in development financing by instrumentalizing knowledge on human capital – an asset to be accumulated through judicious investments in markets for self-betterment. Through its HCI the World Bank has expanded its global benchmarking practices, encompassing new domains and quantified predictions of future productivity, in the hope of shaping domestic policy processes. I also was a co-author on a major publication in the medical journal The Lancet, “The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion” and also published a piece based on this work in Social Science and Medicine – Population Health with coauthors titled, “The origins of the 4 × 4 framework fornoncommunicable disease at the World Health Organization.” This piece traces why the WHO focused its NCD policy on narrowly constructed interventions to address behavioral “lifestyle” risk factors as well as pharmacotherapy for physiologic risk factors, initially packaged as an integrated approach in high-income countries, but subsequently extended to low- and middle-income countries where they have failed to address much of the burden among very poor populations.

Finally, I have two pieces very recently published. One, with my co-author Joseph Harris currently under review at Social Science Quarterly, is titled “Comparing Disciplinary Engagement in Global Health Research across the Social Sciences.” It compares the contributions of four major social science disciplines—anthropology, economics, political science, and sociology—to the study of global health. The second piece, with co-authors, has been published with the premier medical education peer reviewed journal, MedEdPORTAL, and is titled “Preparing Doctors in Training for Health Activist Roles: A Cross- Institutional Community Organizing Workshop for Incoming Medical Residents.” It is based on survey results and our experience with incoming medical residents to Boston-area teaching hospitals during a weekend-long public narrative and community organizing training workshop.

Future Plans

My dissertation’s empirical evidence and theoretical contributions have opened a fertile space for future sociological research. For instance, I am interested in expanding my approach to the ways university- based engineers and design experts, seeking to make a difference in global health, construct their projects in the context of a materially and symbolically “tight” field of global health practice. Global health engineering and design projects are ubiquitous on American university campuses. Better understanding the construction, boundary work, material manipulation, and symbolic framing of these projects could bring fresh insights into the new political sociology of science, field theory, as well as practice-level new materialism research in STS.

Additionally, I am interested in expanding my approach to more explicit campaigns and efforts to engage in contentious politics in global health. My research to date has mostly focused on the epistemic politics of scientized global health governance. In the future, I am interested in turning to subaltern and radical health justice social movements in the Global North and Global South, to understand the diverse material, epistemic, narrative, cognitive, and emotional resources constructed and deployed in the context of their struggles. Specifically, COVID-19 has unleashed a wave of reinvigorated global health activism – from widespread protest actions directed at vaccine manufacturers who have pocketed billions while seemingly slow-walking distribution in the impoverished world to multi-racial domestic coalitions seeking to win national and state-level policies to mitigate viral spread domestically. What kinds of knowledge are made and deployed in these struggles? How does this knowledge compare with hegemonic public health science and what are we to make of the difference?