Abstract
Abstract Despite the swift development of Vietnam's water supply and sanitation (wat/san) sector, over the last ten years there have been 1.5 million annual documented cases of diarrhea. Western perspectives blame insufficient medical or economic advancement for failing to prevent diarrhea and its treatment, failing to grasp how disease is shaped in the cultural, moral and political domain. This article examines the nature and function of public health policy and discourse against the spread of the disease in Can Tho City, Mekong Delta. Some 94 qualitative interviews were conducted with government representatives, medical staff and water experts, and a survey of 131 households in urban and rural areas. Focusing only on improving the construction of wat/san 'hardware' does not improve 'cultural software', and ignores the needs of vulnerable minorities, compromising the control of diarrhea. I also show how state discourse follows neoliberal approaches in individualizing health responsibilities, and moralizing disease. Local (mis)perceptions and risky behaviors emerge as the result of structural constraints that include poverty, a lack of access to useful health information, and the cultivation of stigma around diarrhea. These types of health dispossessions serve a political purpose, where the state escapes responsibility for public health failures, and thus enhancing its efforts to maintain legitimacy as a good implementer and a 'caring head.' Keywords: Vietnam, public health, health individualization, moralization of disease, blame discourse, diarrhea.
Highlights
Despite the swift development of Vietnam's water supply and sanitation sector, over the last ten years there have been 1.5 million annual documented cases of diarrhea
Health messages for diarrhea prevention: de-prioritization in a system of hierarchy In the 1970s, the Vietnamese government was mobilizing and training many workers on full salaries to spread public health messages, while social behavior compliant to public health principles already constituted an official obligation for citizens (Bloom 1998)
The findings and analysis in this article contribute to a more nuanced understanding of diarrheal disease as a socio-political and cultural phenomenon, turning attention to the circulating discourses and onthe-ground practices related to diarrheal disease
Summary
Despite the swift development of Vietnam's water supply and sanitation (wat/san) sector, over the last ten years there have been 1.5 million annual documented cases of diarrhea. Local (mis)perceptions and risky behaviors emerge as the result of structural constraints that include poverty, a lack of access to useful health information, and the cultivation of stigma around diarrhea. These types of health dispossessions serve a political purpose, where the state escapes responsibility for public health failures, and enhancing its efforts to maintain legitimacy as a good implementer and a 'caring head.' Keywords: Vietnam, public health, health individualization, moralization of disease, blame discourse, diarrhea. A tendency over the last century and a half has been to 'scientize' complex phenomena rather than democratize decision-making processes about them As a result, such phenomena have received apolitical explanations and responses Disease is thereby disconnected from its biophysical and cultural environment and, as a consequence, stripped of its political dimensions
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