Tuberculosis: Changing Concepts of Globalization and Boundaries in the Context of Health

Abstract

Background: Earlier theorizing portrays globalization as a process that vaporizes geographic borders. This research focused on the construction of new boundaries in the context of globalization and health, specifically regarding the airborne contagious disease of tuberculosis (TB) and results of TB stigma.

Objective: This study examined the implication of stigma to the creation of geographic, economic, and sociopolitical boundaries to people with TB.

Methods: An ethnographic study of health knowledge was carried out across the three levels of health care system composed of policy makers and program managers (15), health providers (36), persons affected by TB (PATB) (14) and lay persons (30). A semi-structured interview schedule was used to elicit information from a purposive sample of 36 health care providers including 11 physicians at private and public health facilities and 14 adult PATB in Baguio City, Philippines. The analysis also drew from a literature review on the historical, socio-cultural, and medical context of the Baguio City data.

Results: Analyses of globalization tended to focus on the blurring of national borders; however, this study indicated that globalization can also create fluid social boundaries when healthier, wealthier people avoid human bodies belonging to individuals who are uneducated, unemployed and unhealthy. In this analysis, the movements of people in normal daily life in a generally healthy population were termed person flows. Stigmatized persons affected by TB demarcate social boundaries and inhabit areas that are analyzed as spaces of isolation, with restricted movement of persons affected by TB and avoidance by the general population.

Conclusion: Globalization can also involve a social process of building boundaries that are locally, regionally, and internationally constructed and sustained. These boundaries subordinate those affected by TB and their neighborhoods, reinforcing structures of disparity in health, medical treatment, and income.