Trnka, S.One Blue Child: Asthma, Responsibility, and the Politics of Global Health. Stanford: Stanford University Press. 2017. 280pp £74 (hbk) £22.99 (pbk) ISBN: 978‐1503601130.

Abstract

Susanna Trnka is a social and medical anthropologist whose collection of work focuses on the body, citizenship, and subjectivity. She has published extensively in the areas of childhood, embodiment and illness, gender politics, political violence and memory, to name a few. One Blue Child reflects her broad grasp of the complex webbing of social phenomena, state and citizenry responsibility. Trnka's focus on asthma in children and existing in childhoods is indirect. Rather, her positioning of the asthmatic child offers fertile ground in which to analyse the meeting site of neoliberal health care policy in the context of self-management because of the very idea that children and childhoods are spaces of silences and slippages, of relative autonomy and co-creativity. Her ideas echo a Foucauldian conceptualisation of governmentality and biopower where the body becomes the site of the messy play between state regulation, health and illness, power and self-autonomy. In her book, Trnka seeks to explore the trend of current neoliberal health reforms as they present in their myriad forms of practice. This analysis is read through the lens of childhood asthma in two countries: the Czech Republic and New Zealand. The two case-study countries provide a moot discussion in which Trnka carefully considers the ‘interrelationality of healing’ (p. 7), exploring how global health policies synapse with individual autonomy around healthcare decisions. This kind of exploration highlights the fractures and slippages in keeping a population healthy, adding her scholarship to a growing body of work that deals with global childhood health and well being. Her work will appeal to those working in public health, those in health systems management and analysis, health practitioners, and could even be attractive to lay individuals grappling with the inconsistencies within the health care setting. Additionally, there are some secondary arguments that the book raises, such as familial healthcare responsibilities, gender role-playing in healthcare management and childhood embodiments of illness that provide interesting analyses and coverage for those in the sociomedical research field. Trnka positions three central arguments around the idea of advanced liberalism. The first is that whilst the neoliberal rhetoric of self-responsibility and empowerment entrusts responsibility of health in the individual, it is also underpinned by a network of interrelated macroeconomic and political structures that bind a patient's recourse to health to a continuum of state-regulated care. As such, health, the individual, and the state are interlinked on an inexorable journey of finding well being. Her second argument builds on the first by interrogating sites of patient power in co-creating health in their own bodies. This, she argues, is a radical shift in that it positions the patient's voice far more centrally than it has ever been in the historical-medical world. Her third argument highlights the various avenues patients, parents, and medical providers take to find health in the Czech Republic and New Zealand. These avenues often embrace mind-body therapeutics that facilitate healing in the asthmatic body and extend the discussion away from the pharmaceutically driven medical world to include alternative remedies. These arguments reveal just how varied and multiple the avenues to health are. The content covered in the book is extensive and subject areas are seemingly jig-sawed into awkward analyses between the two countries. Whilst there is an implicit and perhaps too subtle explanation that the comparative analysis is less about the two countries per say and more about the presentation of chronic illness in neoliberal health economics (pp. xi, 229), key arguments and analyses suffer enormously from this rather confusing narrative structure. Additionally, whilst One Blue Child offers a lot of content to grapple with, it fell short in its ability to hold the three arguments consistently. The arguments seemed to buckle in many parts of the book, in part due to the plethora of sub-topics it attempted to address under the umbrella of global health policy in practice and the country-specific comparisons. Additionally, the figuration of childhood and children seems to disappear almost completely once the pace of the book picks up. Despite these short-fallings, the book's greatest strength lies in its cross-cultural examination of health politics that allows us to interrogate how asthma, as a medical condition, is tightly bound to economic, environmental and social circumstances. To close, Trnka outlines four ‘principles’ (p. 226) or recommendations that invite a more comprehensive understanding of chronic illness realities in a constantly changing global health arena. These recommendations act as a summary of her main arguments. They build a case for a more considered action plan that calls forth a collectivised, social welfare programme as opposed to a strict neoliberal, individuation of resource allocation that exacerbates socioeconomic inequities. It is an interesting end to the book that ushers in an important reflection about citizens' private and public pursuits of health within an ever-growing profit-driven global pharmaceutical industry.