Cancer and the Politics of Care: Inequalities and Interventions in Global Perspective By Linda Rae Bennett, Lenore Manderson, Belinda Spagnoletti, London: University College London Press. 2023. pp. 272.
University of Cambridge
Cancer and the Politics of Care is an exploration of how, in the terms of Christopher Wild, “cancer is lived differently” (2019, 4). Available through open access, the book’s 11 chapters are based on ethnographic fieldwork in areas ranging from Brazil, India, and Senegal to the United Kingdom and are brought together in an introduction by Linda Rae Bennett and Lenore Manderson. These editors cite the recent International Agency for Research on Cancer report, written by Wild and colleagues, as an example of a body of epidemiological literature that describes how “types of disease, their distribution, survival, and mortality reflect social inequalities within and between countries” (2). While this work usefully details vast discrepancies in cancer prevention, survival rates, and responses according to factors that include education, income, race, gender, geography, and so on, Bennett and Manderson contend in their introduction that such scientific texts pay little attention to explaining the complexities of how cancer is actually “lived” differently. Building on a long history of anthropological work that highlights how these differences emerge in practice, the book is presented as a response to wider calls to “humanize” our understandings of the global cancer divide (4).
Contributors to the volume consider how “cancer”—a term used to describe a wide range of conditions—is “lived”—that is, experienced, felt, embodied—differently, as well as how the conditions of living determine who gets cancer and the forms of care they receive following a diagnosis. The notion of the “politics of care” is introduced as a tool to link analytical levels, bringing together human experiences of care and the ordinary circumstances of everyday lives with political and systemic problems of inequity. Authors in the volume employ the concept productively to explore how access to resources among families, health systems, nation-states, and the global economy create variable “carescapes” for people who become patients through a diagnosis of cancer. The idea of the politics of care enables researchers to surpass reductive categories such as the Global North and Global South, instead focusing on how “difference” is created and lived at a multitude of levels. Nancy J. Burke’s chapter does so particularly skillfully, focusing on how “patient navigators” promote timely access to diagnosis and treatment among people with cancer who are under- or uninsured in the United States. Her ethnography illustrates how patient navigators use humor to help these patients manage fear, embarrassment, and the side effects of treatment. As well as drawing attention to structural violence and inequalities, Burke offers insights into the daily textures of life for people who become cancer patients under difficult circumstances, highlighting that successful care depends on interpersonal connection and laughter, as well as resource availability.
Other chapters offer critical perspectives on biomedical efforts to address inequalities in cancer outcomes. Cecilia Coale Van Hollen studies cancer screening camps in southern India, arguing that efforts to increase uptake of breast and cervical screening among lower-class women are ineffective because they inadvertently stigmatize particular behaviors and are out of touch with people’s everyday lives. Also seeking to situate “non-engagement” with preventative interventions, Natalia Luxardo and Linda Rae Bennett suggest that, for socially and economically vulnerable women who face “overlapping continuums of violence” in Argentina, the rejection of cervical screening or attending intermittently is itself preventative, protecting women against the harmful impacts of a health system that is not safe for them. Kelly Robinson and Ignacia Arteaga Peréz turn a critical lens back on themselves as researchers. These anthropologists carried out fieldwork in UK communities deemed “hard to reach” by applied health researchers. They describe realizing that the terms they used were embedded with their own assumptions: Robinson and Peréz had understood “care” positively, meaning they had initially failed to grasp that “care” meant coercion and exclusion to their interlocutors in a drug and alcohol addiction recovery center who had experienced incarceration and the removal of their children by state actors. Such “epistemic opacity” can lead researchers to miss what matters most to people, ultimately damaging trust. These authors collectively highlight that both healthcare and research can be a cause of inequalities, as well as part of the solution.
With its clear introduction, the book is likely to be interesting and accessible to undergraduate students, as well as graduate students and academics. It also may appeal to the clinicians, scientists, and policy makers who, along with patients, form the focus of contributors’ ethnographic work, enabling them explore the heterogeneity of sometimes taken-for-granted categories like cancer or care.
Many contributors made the “flow of support and engagement” (15) between researchers and research participants clear, with several describing efforts made to meet the immediate needs of the people in marginalized communities with whom scholars worked. What is largely implicit here, however, is the flow of support between anthropological researchers and biomedical organizations. Analysis of the authors’ acknowledgments highlights that many were at least partially funded by biomedical funding bodies. This complex relationship between medical anthropologists and medicine requires ethnographic attention; biomedical practitioners’ funding of research into “social issues” such as inequality has a particular history that felt taken for granted here. Exploring the expectations and assumptions of the organizations funding much of this work would have served to situate the book better in the context of a recent emphasis on “inequalities” that reaches far beyond our discipline. Nevertheless, the book makes a valuable contribution to a long history of anthropological work on the diverse diseases that get called “cancer” and the variable experiences of the people who work to prevent, treat, and live with them.
Wild, Christopher P. 2019. “ Social Inequalities and Cancer: The Imperative to Act.” In Reducing Social Inequalities in Cancer: Evidence and Priorities for Research, edited by Salvatore Vaccarella, Joannie Lortet-Tieulent, Rodolfo Saracci, David I. Conway, Kurt Straif and Christopher P. Wild, 1–6. Lyon, France: National Agency for Research on Cancer.