Global Health Narratives aims to bring accounts and issues from the burgeoning field of global health to middle and high school students. Authored by academics and health advocates, the book pursues this goal admirably, introducing a breadth of recent ideas about the connection between health and society to an audience seen as having a growing global consciousness. Yet, while exhibiting the best of intentions, Global Health Narratives ultimately treads a thin line between ethnography and folktale, highlighting a balance between incisive observation and the distorting conventions that seem all too frequently acceptable for educational materials. The volume’s development from “an interdisciplinary seminar on narrative health convened by Emory University’s Center for Health, Culture and Society” (xi), and its publication through an academic press, show its authors’ desires to bridge the standards of higher education with the needs of secondary school instruction. Consequently, the book and its accompanying website (http://www.ghn4c.org) raise important questions about the ways public health advocates use the convention of narrative to inspire coming generations.
The thirty-one narratives in this volume, arranged according to continent and country, offer anecdotal perspectives on important health-based matters across the globe: mercury poisoning in Mongolia, HIV/AIDS stigma in Thailand, malaria in Mali, tuberculosis and HIV in Romania, obesity in American Samoa, war refugee status in the United States, airborne particle pollution in India, physical abuse in Virginia (USA) and South Africa, and so on. To unify this dizzyingly wide range of situations, the authors present the stories through the eyes of children—presumably (and reasonably) so young readers can relate more effectively to the ways different cultures address questions of health. This choice, borne of due academic consideration—foreword author Kate Winskill cites psychologist Jerome Bruner’s theories about narrative as an inspiration—may cause readers to “perfink” (perceive/feel/think, in Bruner’s terms), but it also weakens the authors’ ethnographic credibility. Though Winskill notes that the authors are “drawing on their own experiences” (xi), the book offers little way to know if, for example, Zoilita, the Salvadoran schoolgirl who leads her class’s Rubella vaccination drive (112–17), is real, a paradigm, or an agent of the author’s ideal scenario (and, consequently, ideological stance). Some writers imply in their narratives that their stories profile real people (as in the account of Amra, a Muslim violin enthusiast who survives the Bosnian war [201–10]). Aside from such anecdotal cues, however, the lack of photographs, notes, or other documentation offers little guidance. When presented to youth, these writers seem to assume, the stories themselves are enough; they do not need to supplement them with even some of the meticulous documentation considered standard for the field.
The unclear provenance of these accounts highlights larger concerns about the book’s purpose, since the stories too often lead to forced moments of “clarity” and dictated moralism. Nearly every account includes a seemingly compulsory detour from the story at hand through a clinical description of the issues under discussion, either through an adult character—usually a teacher or doctor—or an omnipresent narrator (“‘I told Dr. Sigdel about Naba Raj’s problem. The doctor said that Naba Raj has epilepsy’” [9]). All the narratives have benign endings, concluding with the main character avoiding medical tragedy, staving it off, or simply coming to a personal realization about health through a key personal encounter. With one exception, all the chapters assiduously avoid discussions of sexuality—a major issue in global health discourses, particularly among teenagers. Western medicine, moreover, conspicuously appears as a universal source of comfort and information in this book, and several of the protagonists openly decide to become doctors after positive experiences with the system. Without sources for these stories, it becomes hard to determine where observation ends and ideology begins. Do these narratives present real people, or do they represent the political positions of public health advocacy? Perhaps unintentionally, that ambiguity muddies the book’s effectiveness as a representation of a probing and textured global health field.
I consequently felt a sense of pedanticism pervading these accounts, emphasizing specific moral action without fully coming clean to the reader about the derivations of those directives. There is nothing particularly wrong with this approach in theory, given that Mendenhall ultimately hopes the book will “provide youth with a context for understanding the importance of healthy communities” (xv) and empower them to take to action. Yet it is unclear whether Mendenhall actually tested these narratives with the book’s intended audience; and I oftentimes wondered whether a seventh-grader (or older) would have the patience to read through some of the volume’s most heavy-handed lessons. The dialogue can at times seem patronizing and disingenuous (such as the obviously fake e-mail messages in an otherwise interesting story of teen dating abuse: “R U OK? I miss hearing from U. I hope U are fine” [140]; or one character’s less-than-subtle mention of an actual abuse hotline phone number during an exchange later in the same chapter [144]). And even though the contributors clearly aspired to offer parables highlighting young persons’ medical choices in times of stress, too often these stories come off as thinly veiled assertions of a Western medical agenda. Do young people really need this kind of carefully controlled lens into public health, or might they benefit more from less heavily mediated glimpses into vibrant, complex societies’ discussions over body and mind?
These critiques notwithstanding, the editor and authors harbor great ambitions with this book; and as a group these brief stories take clear steps to achieve such ambitions. Can Global Health Narratives find effective use within a secondary school setting? Certainly, if schools will make the space: Mendenhall’s work establishes a benchmark, adapting key insights from an increasingly important field to the perceived needs of a younger population. On an academic level, however, the book raises important issues about the role of narratives in the transmission of public health ideas, and the obligations public health advocates have toward presenting such narratives honestly and meaningfully to the people who will be their successors.
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[Review length: 986 words • Review posted on August 25, 2009]