ORIGINAL RESEARCH article
Sec. Health Communication
Volume 4 - 2019 | https://doi.org/10.3389/fcomm.2019.00067
Critical Health Communication Method as Embodied Practice of Resistance: Culturally Centering Structural Transformation Through Struggle for Voice
- 1School of Communication, Journalism and Marketing, Massey University Business School, Auckland, New Zealand
- 2Department of Communications and New Media, Faculty of Arts and Social Sciences, National University of Singapore, Singapore, Singapore
- 3Department of Communication, The Ohio State University, Columbus, OH, United States
- 4Department of Indonesian Studies, University of Sydney, Sydney, NSW, Australia
- 5Department of Communication, Arizona State University, Tempe, AZ, United States
- 6School of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
- 7Department of Communication, Greenville University, Greenville, SC, United States
The Marxist roots of critical methodology envision method as anchor to an emancipatory politics that seeks structural transformation. Drawing on our negotiations of carrying out culture-centered health communication projects amidst neoliberal authoritarianism, we explore the nature of academic-activist-community collaborations in envisioning democratic infrastructures for socialist organizing of health. Method is thus inverted from the hegemonic structures of Whiteness that construct extractive relationships perpetuating existing and entrenched health inequities to partnerships of solidarity with subaltern communities committed to a politics of “placing the body on the line.” We work through the concept of “placing the body on the line” to depict the ways in which the body of the academic, turned vulnerable and weaponized in active resistance to neocolonial/capitalist structures, disrupts the hegemonic logics of power and control that shape health within these structures. Examples of culture-centered projects at the global margins offer conceptual bases for theorizing embodied practice as resistance to state-market structures that produce health injustices. The body of the academic as a methodological site decolonizes the capitalist framework of knowledge production through its voicing of an openly resistive politics that stands in defiance to the neoliberal structures that produce health inequities. We challenge the communication literature on micro-practices of resistance, interrogating concepts such as “strategic ambiguity,” “pragmatic interventionism” and “practical engagement” to offer method as embodied practice of open/public resistance, as direct antagonism to state-market structures. Through the re-working of method as embodied resistance that is explicitly socialist in its commitment to imagining health, culture-centered interventions imagine and practice Marxist advocacy and activist interventions that disrupt the intertwined hegemonic logics of capital and empire.
After 6 years of creating interventions that challenged health-threatening neoliberal policies across Asia's margins, the Center for Culture-centered Approach to Research and Evaluation (CARE) moved its home out of the authoritarian context of Singapore (see Dutta interview in Today 1,2). This movement tells the story of complex negotiations of the body, the body of the academic and the body of a collective committed to building infrastructures for subaltern voices, constituted amidst the authoritarian workings of institutional, bureaucratic, and state power. In performing our labor as academics building communicative infrastructures for subaltern voices (Dutta, 2018), we were subjected to pressures, techniques of silencing, tools of disciplining, and pathways of co-optation from various arms of the system3. These pressures, experienced as interrogations, meetings, questions, and directives to change the courses of culture-centered interventions as they emerged through the presence of subaltern voices, materialized on our collective body. Our practices were turned into subjects of scrutiny, accused of irregularities as they sought to imagine health as a human right. For instance, one of us was accused in an audit of hiring activists in human rights, not health communication. As the Center continued/s its work in Singapore, China, and in increasingly authoritarian contexts (such as India where activists-academics are killed in broad daylight for challenging the fascist Hindutva forces), various partnerships with communities and community organizers, civil society groups, and activists enable the ongoing work of co-creating communicative infrastructures for subaltern voices. These relationships offer anchors for sustaining our embodied resistance, with ever-expanding forms of state scrutiny and repression in the service of global capital.
The body manifests the effects of state control, expressed in symptoms such as fainting, throwing up, experiencing waves of shiver, and running high temperatures4. These embodied effects, folded into intimate and familial spaces of affect, reflect the negotiations of everyday anxieties and stress constituted in the struggles to co-create subaltern voice infrastructures. At cognitive and affective levels, the presence of the body in solidarity with subaltern struggles for voice disrupts the state's neoliberal governmentality. Health and well-being emerge as the sites of struggles for subaltern voice, inverting the neoliberal ideology of health communication that constrains the role of communication to individual-level interactions and state-driven individualized campaigns of behavior change (Dutta, 2005). Moreover, the state's rhetoric of engaged/participatory governmentality as a model of smart governance (Kong and Woods, 2018) is disrupted by accounts of erasures of voice, participation and articulation emerging from the subaltern margins. At the material level, the presence of the academic as activist in solidarity with subaltern struggles disrupts the organizing of knowledge within hegemonic structures (Dutta, 2019a,b).
The Marxist5 roots of critical methodology envision method as an anchor to an emancipatory politics that seeks structural transformation through collectivized formations of the dispossessed (Freire, 1973; Wright, 1993; Horkheimer and Adorno, 2002). This turn toward emancipation through work with margins anchors the culture-centered approach (CCA hereafter), embedded in an acknowledgment of exploitation and emancipation as universal phenomena, re-worked through the specifics of context as a localized site of agentic struggle (Dutta, 2008, 2011, 2015). The process of cultural-centering therefore is one of co-creating communicating infrastructures through solidarities with the subaltern margins. The three key methodological tools of the CCA, voice, reflexivity, and structural transformation (Dutta and Basu, 2008; Dutta, 2018) are embedded in embodiment, the physical placing of the body of the academic amid the subaltern struggles for voice. Voice, and more specifically subaltern voice, emerges within this struggle as the site of articulation and structural transformation (Dutta, 2004a,b). While the interrogation of the politics embodied in hegemonic texts can offer an entry point into struggles for counter-hegemonic formations (Lupton, 1994; Dutta, 2005), we argue that such textual analysis of hegemony is only (can only be) a starting point for culture-centered interventions into health communication (Zoller and Dutta, 2009), with the actual work of structural transformation realized through questions of what it takes to co-create infrastructures for subaltern voices. Beyond the works of pedagogy in the classroom and publication of findings in largely inaccessible journal articles or books, cultural centering is an invitation to placing the body of the academic in solidarity with subaltern struggles in the public arena.
Noting the thorough co-option of culture and critique within the neoliberal formations of neoliberal academia, with the privileged postcolonial academic working within the structure of capital (Dirlik, 1994; Ahmad, 1995), we explore the turn to culture in the CCA as a call toward an active politics of living a critical life (Ahmed, 2017), embodied in continual suspicion toward hegemonic structures through the placing of the body, our body/ies, in acts of resistance to state-market structures and in solidarity with the subaltern margins (Dutta and Basu, 2013; Bradford and Dutta, 2018). This critical reading forms the basis for the ongoing interrogation of the politics our bodies inhabit. Cultural centering as a methodology for building voice infrastructures for the subaltern margins is therefore also about de-centering the hegemonic formations that deploy culture to erase voices. It is in this labor of placing the body amid subaltern struggles of voice that theoretical lessons for communication emerge in the context of transforming the structures that constitute health inequalities. Based on a critique that the ideologies of the “structural determinants of health” approach, and the individualistic health disparities approach, leave the neoliberal structure intact, with health communication interventions focusing on individualized behavior change (albeit with a nod to structure and incorporation of culture into message tailoring), we suggest that the challenge for critical methodologies of health is one of working out the politics of how to “actually dismantle structures” (Dutta, 2016) that threaten health and well-being of subaltern communities.
Embodiment, as the placing of the body amid the struggle for voice forms the contingent, dynamic, and collectivized basis for cultural centering [see for instance our collaboration with foreign domestic workers in Singapore, in Dutta et al. (2018)]. The work of the critical method is one of embodied struggle, located in carving out a politics of solidarity with the subaltern. While on one hand, we draw our inspiration from the question of the (im)possibility of the representation of subaltern voices in neocolonial and neoliberal structures (Spivak, 2005), on the other hand, we locate our bodies amidst struggles seeking to build voice infrastructures that imagine structural transformations through an explicitly activist politics (Dutta et al., 2014; Dutta, 2018). In this manuscript, based on four case studies, three located in the neoliberal authoritarian regime of Singapore, and the fourth located amid the ongoing turn toward authoritarianism in neoliberal India, we articulate the salience of embodiment as the basis for returning to the critical in critical health communication. The centrality of voice as the basis of structural transformation speaks to the communicative anchor of embodied critical method.
We understand the work of placing our bodies in solidarity with struggles for communicative equality as embodiment, where critique itself is the praxis of resisting structures, materializing in academic-activist-community collaborations that envision democratic infrastructures for socialist organizing of health. Culture-centered work therefore is also the work of solidarity with activists and human rights advocates that seek to build radical democracies rooted in communicative equality (see for instance Dutta, 2019a). Method is thus inverted from the hegemonic structures of Whiteness that construct extractive relationships perpetuating existing and entrenched health inequalities through individualizing frames to partnerships of solidarity committed to a politics of “placing the body on the line.” Authenticity as the basis of embodied health communication method turns the critical gaze on our own bodies, offering a framework for interrogating the decisions we make in our everyday work of co-creating voice infrastructures. We work through the concept of the “body on the line” to depict the ways in which the body of the academic is turned vulnerable and is weaponized in active resistance to colonizing/capitalist structures, disrupting the hegemonic logics of power and control that shape health within capitalist-colonial structures.
The body of the academic placed on the line in solidarity with subaltern struggles for voice forms the basis of the methodology of resistance. It decolonizes the capitalist framework of knowledge production through its voicing of an openly resistive public politics that stands in defiance. We challenge the communication literature on micro-practices of resistance, “strategic ambiguity” (Johansen, 2018), “pragmatic interventionism” and “practical engagement” (Koh et al., 2017) to offer method as embodied practice of public resistance to power, as antagonism to state-market structures of power and control. Through the re-working of method as embodied resistance that is explicitly socialist in its commitment to imagining health and democratic in its articulation of opportunities for voice, culture-centered interventions imagine and practice advocacy and activist interventions that disrupt the hegemonic logics of capital and empire.
The culture-centered approach (CCA) conceptualizes inequalities in health outcomes as reflections of broader structural inequalities, situating these inequalities in relationship with communicative inequalities (Guha, 1999; Dutta, 2008). The theorization of communicative inequalities in the CCA interrogates the hegemonic concept of communication inequalities as inequalities in distribution of a communication object/channel, such as a mass medium, in a society (Dutta, 2016). Noting that the dominant framework of communicative inequalities in mainstream communication theory reflects the capitalist and colonialist role of communication as an instrument for disseminating the techniques/technologies of the market across the globe, the CCA inverts the concept of communication inequalities by exploring the distributions of opportunities for voices. Drawing from Subaltern Studies theory (Dutta, 2008), it argues that subalternity, as the condition of being erased from dominant discursive spaces, is produced through the erasure of the subaltern from spaces/sites/infrastructures of voicing. The methodology of the CCA therefore seeks to co-create infrastructures for voices from the margins in partnership with subaltern communities located at the margins. The “right to voice” translates into communication interventions that seek to democratize the sites of articulation of health and well-being. We outline the following key characters of the critical method in the CCA that constitute embodied practice, in each case depicting the roles negotiated by the academic engaged in the struggles for subaltern voices to be heard through partnerships with subaltern communities.
Commitment, the dedication to a cause, translates in the CCA as a dedication to “learning to learn from below” (Spivak, 2005). The emergence of subaltern voices into the hegemonic mainstream disrupts hegemonic articulations, usually resulting in structures responding through co-option or through threats of violence to silence subaltern voices. Embodied practice is therefore anchored in commitment, forming the basis of transformative interventions in the face of structural/systemic attacks on culture-centered interventions. We note that the structural transformations that are at the heart of achieving health are attained through collective struggles for voice. Commitment therefore forms the very basis of the ongoing struggle to locate health communication research in creating, catalyzing, and collaborating with movements of structural transformation grounded in subaltern voices. Resistance, understood as collective processes of organizing to transform unhealthy structures, begins with the commitment of the research method to listen to subaltern voices that disrupt hegemony (Bobel and Kwan, 2011). Noting the careerist opportunism that inundates contemporary academe, especially in terms of making claims to activism to serve narrow opportunistic, individualistic, or institutionalizing goals [see for instance the discussion on activism as institutionalization by Morris and Hjort (2012)], we emphasize the critical need for demonstrating commitment through the public placing of the academic body in solidarity with subaltern voices, activists, and other academics under attack by the state-market nexus (covered next).
The “No Singaporeans left behind” (NSLB henceforth) campaign (a project on poverty and health inequalities designed by the poor) emerged as an advocacy intervention designed by household members living in poverty in Singapore. The advisory group of low-income families wanted to foreground the everyday experiences of poverty, seeking to open a conversation on poverty in Singapore. They felt that the experiences of health as inaccess are constituted in the erasure of their voices and in the strategic erasure of poverty from discursive projections of Singapore (see Tan et al., 2017). The state's projection of an image of efficient governmentality and its legitimization of authoritarian governance are achieved through its narrative of managerial technologies that ensure minimum standards of livelihood for all its citizens.
Equipped with the findings of a year-long study of the relationships between poverty and health, our research team met with bureaucrats of Ministry X6. The bureaucrats responded to our initial findings on food insecurity and experiences of poverty by stating that food insecurity doesn't really apply to the context of Singapore. As an aftermath of the meeting with the bureaucrats, we were asked several questions by a university bureaucrat Y7 over email, inquiring about the advocacy campaign that was to be subsequently launched. The concern expressed was that the research is political, that running a campaign is political, seen therefore as being beyond the realm of academic work. One of us, the project director, explained through the exchange how the dominant health communication scholarship is formed on the development and deployment of campaigns. It is just that the nature of the health campaign itself becomes different when the poor set the terms of the conversation as opposed to the state or private foundations setting the goals and objectives. Rather than telling themselves how to eat healthy and exercise (the traditional forms of campaigns which are widely accepted and have strong academic/state presence in Singapore, the nation itself being called the campaign nation), the advisory group members in our campaign decided to invert the messaging, instead targeting policymakers and other Singaporeans with the objective of opening up a conversation on poverty. They hope that through this conversation, communicative infrastructures will be built for challenging the neoliberal policies that sustain deep inequalities in Singapore and threaten the health of Singaporeans living in poverty. For our advisory board, the campaign became the basis for making the hidden visible.
When faced with the question, whether to stick to the campaign and its basic message or to “give in” to the diktats of the system/structure, the principle of commitment rooted us. The commitment to listening to subaltern voices and to the control over decision-making in the hands of community participants translated into sustaining the campaign in spite of the pressures and to placing our bodies “on the line” to make sure that the key messages of the campaign were not co-opted. When specific requests for change emerged from the structure, we turned to the advisory group of community members for those decisions, at the same time placing our bodies in the negotiation of the structural pressures. Whereas, the campaign slogan was modified through this process of negotiation, based on decisions made by the advisory group of subaltern community members, the body of the campaign (the narratives, the media channels selected, including placing advertisements in the state-owned media) remained intact. To commit therefore is positioned in contrast to pragmatism, the considered adoption of strategies to adopt to the diktats of dominant authoritarian structures (see for instance Oswin, 2014 critique of pragmatism in the context of neoliberal Singapore). This placing of the body on the line opened up ongoing pressures on the academic body through various forms of surveillance and ongoing interrogations directed at our bodies and at the bodily integrity of CARE by the system.
The CCA calls for (a) co-creating communicative infrastructures for voices of subaltern communities, and for (b) building activist and advocacy interventions that challenge structures. The process of change is embedded in solidarity, in meaningful and tangible partnerships with the subaltern margins, in walking alongside the margins, in friendships that seek change. The work of solidarity transforms into “being there” in the midst of the struggles for structural transformation, in seeding movements, in generating activist threads, in collaborating with movements, and in seeking change anchors with political parties with socialist commitments. Moreover, the work of solidarity is embodied im supporting other academics at risk for their interrogations of structures. That transforming structures elsewhere is intrinsically tied to transforming the structures within Universities is a vital lesson for solidarity.
For our culture-centered interventions, in the aftermath of the NSLB campaign, as the systemic pressures on our collective work increased, we experienced the absence of solidarity with our bodies. As we witnessed the various tactics deployed by the structures, the typical academic advice from radical-sounding academics within the system was to be strategic. Here, the advice on strategy meant changing the public commitment articulated earlier. With various strategies of control in place, our collective work quickly was labeled as “making trouble.” One senior cultural studies academic advised, “Do the poverty work of CARE elsewhere, not just in Singapore.” Another brown postcolonial academic noted, pointing to Stuart Hall, that it's all about the politics of strategic ambiguity and impure politics. This colleague didn't utter a word when she/he witnessed the various techniques deployed on our bodies by the system. Instead, she/he went on to circulate many of the manufactured communicative inversions to cast doubt on the ethics of our embodied work. Another senior cultural studies academic shared over wine stories about how Chinese men in powerful structures have to be negotiated through strategic acts of “saving face,” regaling us with stories of wearing red suits. Solidarity, as we see through the lens of these experiences, when it comes to counting who stands by you amid the confrontation with structures, is liminal, quick to disappear amidst the tall claims of radicality. Yet, where solidarity is sustained, is in the everyday practices of non-academic and academic staff (mostly junior staff), who call out injustice and stand up against oppression when they witness it. For a number of us and a number of the non-academic staff, the performance of solidarity inside of academe and outside of it, with the subaltern margins and with other academics/activists resisting the authoritarian structure, turned into paying the price with our/their jobs. For some of us, this translated into quitting academia entirely.
This notion of solidarity as action is constituted in opposition to the notion of solidarity as rhetorical performance, claims, or posturing. Solidarity as everyday practice emerges within academia often at very sites of non-academic and precarious academic labor, sites that are not often given to making academic careers out of claims to radicality. What became evident in these negotiations is the powerful role of solidarity for the work of the CCA demonstrated by many non-academic and academic staff through their everyday actions and commitments, in the positions of voice they stood behind and in the truth claims they anchored themselves in amid the strategic reproduction of communicative inversions. In the work of CARE, with the recognition that the critical struggle for voices amidst the margins must translate into critical struggles for voices embodied by other academic-activists, one of us, Mohan, took public stances (often being the only senior academic in the institution to take these stances) in solidarity with the academic Pingtjin Thum when he was targeted for interrogating the state's narrative and later blacklisted from participating in academia. This also meant standing in solidarity with activists such as Jolovan Wham and Seelan Palay as they challenged the state's draconian laws restricting freedom of expression and freedom of assembly (see Dutta, 2019a,b). Mohan was interrogated for his allyship with Wham, asked questions about his collaboration with Wham as well as his invitation to Wham to appear on CARE platforms. Solidarity here is the public placing of the body in support for dissenting voices, in visible spaces that are otherwise marked as inaccessible to dissenters, and in making visible the academic value of dissenting voices (especially as these voices are actively projected as un-academic, as having no space within academia). In response to the cancellation of a program on “Dialogue and Dissent” at Yale-NUS College in Singapore, Singapore's Minister of Education delivered a speech in Parliament naming Wham and Palay, stating, “Academic freedom cannot be carte blanche for anyone to misuse an academic institution for political advocacy, for this would undermine the institution's academic standards and public standing.” Mohan responded publicly to this statement, writing blog pieces, opinion pieces, and giving interviews to media.
The CCA critically interrogates academic posturing and claims to radical position that fail to show solidarity in struggles against structure, keep their bodies intact, or even worse, collaborate with structures to institutionalize their so-called radical positions (see for instance Morris and Hjort, 2012). Framing activism as a form of instrumentalism, the collection edited by Morris and Hjort (2012) depicts academic-activism as a strategy for institutionalizing cultural studies in the academe. Activism, depicted in the logic of “institutional action,” serves to institutionalize cultural studies. Drawing on our experiences in dismantling structures, we note that any form of institutionalization can not be the goal of a critical project. Critical theory and methodology, anchored in a commitment to disrupting structures, ought to be fundamentally suspicious of structures, and the accompanying claims to pragmatism, functionalism, and institutionalization. As a communicative inversion, for Morris and Hjort (2012), academic-activism is molded in a narrative of pragmatism that works within institutional structures to further the hegemony of the institution, located within the hegemonic networks of institutional power. Solidarity is depicted in this section, is an antidote to such pragmatic performance of radicalism that “communicatively inverts” activism to accommodate power for institutionalizing careerist trajectories of areas, groups, and individuals.
The “Respect our Rights” campaign, created by foreign domestic workers in Singapore, brought in domestic workers into the spaces of decision-making in the university, in civil society, and in policy spaces, from which they have historically been absent. Many of our advisory group meetings, creative workshops, and production work were being held in the University. In many such instances, the presence of the domestic worker body in the University, an elite structure, disrupted the normative expectations of the structure, leading to academics making comments such as “What are these doing here?” Hearing these comments foregrounded the question of our location in academe, interrogating the meaning of authenticity within academic spaces.
The negotiation of authenticity, tied to the question of the identities we perform in the University, is fraught with tensions that are made evident in culture-centered collaborations. Presence of foreign domestic workers in the spaces of the university for instance, disrupt the norms of the hegemonic structures of the university. As these norms are disrupted, the authenticity of our own position is brought to question. Authenticity emerges from the recognition that the radical position in the neoliberal academe has been turned into a seduction for the market (Dutta and Basu, 2018). The experiences of our bodies individually and collective often drew attention to the powerful dilemmas we had to negotiate, with our own privileges within the academe. On one hand, the projects of CARE decorate brochures and websites, tied into claims of social impact and sustainable development goals (SDGs). On the other hand, our everyday work at CARE is constantly subjected to scrutiny and pressures.
From critical performance to the branding of social justice as promotions of the neoliberal university, “communicative inversions” keep intact the status quo. Critical health communication, captured within this tendency, is rendered apolitical, disconnected from the politics of change being fought everyday in the University, in the communities surrounding the University, and in the funded change projects. The thorough co-optation of the critical position within neoliberal university structures calls for an active politics of authenticity that turns the critical lens on the self and its commitments. Through authenticity, being true to self, critical health communication methodology turns the lens on the academic, her/his complicity in knowledge production, and the role of embodiment as a way of connecting to struggles for transforming structures that threaten health.
Practical Interventions as Resistance
In this section, we offer examples of practical interventions as embodied methodology of resistance, depicting how the concepts of commitment, solidarity and authenticity play out in these interventions. Working through specific instances of culture-centered interventions built on solidarity with the oppressed, we bring out key concepts of embodied methodology as critique. The nature of critique, we hope to demonstrate through these examples is located in the body of the researcher placed in the middle of the struggle for voice. Cultural centering, as a method for co-creating communicative infrastructures for the voices of the subaltern, is an active politics of the body in crafting counter-hegemonies amid hegemonic formations that actively work to erase subaltern voice. In this sense, we begin with the identification that subalternity as the act of erasure, works specifically through processes, forms, techniques, and strategies that work to erase the subaltern voice. The condition of subalternity is produced because the subaltern voice is unheard, because the dominant social, political, and economic structures work to un-hear the subaltern voice. The work of cultural centering then is about building active solidarities with subaltern communities on grammars of voice and advocacy so the subaltern voice of heard. In the methodology of embodiment adopted in the context of the CCA, the question of solidarity guides the choices made by academics. Working through power and interrogating its workings, the practical interventions shared in this section work actively through collective processes to disrupt it, to interrogate and transform the hegemonic narratives circulated in the structures that violently erase subaltern voices.
“No Singaporeans Left Behind” and Embodied Resistance
Cultural theorists have long asserted that social relations of power produce bodies that are disciplined and resistant (Foucault, 1995). Embodied resistance provides a framework in understanding the everyday lives of those who violate socially constructed social rules and conventions (Bobel and Kwan, 2011). It is through this lens then, embodied resistance is viewed within “oppositional action” that challenge contextual norms that is rendered in many forms (Hollander and Einwohner, 2004). Such has been the case of the NLSB campaign in Singapore, where poverty is considered an ‘Out of bound” (OB) markers. The silence around poverty in Singapore translates into the absence of discourses on poverty when this project started in 2012, and the systematic erasure of the voices of the poor from the discursive space. The poor emerge in state-controlled discourses as low-income recipients of welfare, with policy, expert, and civil society discourses debating on the appropriateness of support for the low-income. Hegemonic discursive constructions reproduce the narrative of welfare-dependent, lazy poor to uphold the state-crafted neoliberal ideology of smart human capital as the basis for Singapore's progress.
In April 2016, the Center for Culture-Centered Approach to Research and Evaluation (CARE) at the National University of Singapore launched an online campaign to raise awareness on poverty in Singapore, built by an advisory group of community members living in poverty. The campaign, titled “No Singaporeans Left Behind,” was the first campaign in Singapore driven by individuals who were living in poverty, based on research they guided, storyboards they created and owned, and communication strategies they designed. The campaign was conceptualized and designed by an advisory committee comprising 10 men and women who were from the low-income community in Singapore. Over the course of seven months and six regular meetings, the advisory committee came together to identify the key issues affecting the low-income in Singapore, brainstormed possible solutions and interventions to raise public awareness, and directed the design and production of the entire campaign. This process was informed by a multi-team ethnography comprising over 250 h of participant observations, and 200 in-depth interviews, anchored in decisions and guidance offered by the advisory board. Advisory members participated in making sense of the emergent data, thus guiding the white paper that would form the infrastructure of the campaign.
Ownership of the decision-making infrastructures in the hands of community members meant that the process itself was an inversion of the authoritative model of managing low-income households. The 30 days-campaign materials included a print advertisement, a 1-min video advertisement screened online, a dedicated website, with links to the White Paper, social media pages on Facebook and Instagram, and a 30-min documentary. As part of the campaign plan, two workshops focusing on key topics such as financial assistance, aging issues were organized to bring together advisory board members practitioners, NGOs, and academicians. Various bodies of the state were invited to the conversation, but did not participate in them because of the narrative control held by advisory group members. The workshops themselves emerged as transformative sites, inverting the dominant method of conducting engagement and dialogue driven by the state. The workshops also embodied confrontations in their public design; the advisory group wanted the workshops to be public so the discussions with various officials could be open to anyone. When we met with bureaucrats in the state structure with the invitation to the workshop, we were met with sermons on how the definition of “food insecurity” depends on context and that language such as “Voices of the poor” doesn't work in the context of Singapore. One such meeting also initiated an entire cycle of surveillance of the NSLB campaign and the broader work of CARE.
The NSLB campaign materials function as a counter-narrative to the mainstream discourse articulated by the state. The perspective of “resistors” is interrogated viz-a viz the socio-cultural relations that act on individual bodies. Singapore is a city-state, dubbed one of the four Asian Tigers in the region. The high-economic growth coupled with rapid industrialization and exports have facilitated the city-state to be in line with the wealthiest nations. Thus, there are pervasive and conscious efforts to project Singapore as an exemplar city-state, and Singaporeans as worthy of being considered world-class and cosmopolitan. Against this global imaginary, narratives of poverty are restrained from the public sphere.
The campaign sets out to disrupt the notion of “happy, urban dwellers” and invoke an alternative urban futurity through embodied resistance. The voices and stories serve as powerful resistance identity that disrupts monolithic frames of the poor, often viewed as lazy, unwilling to work, and therefore making poor life decisions. In particular, the 30-min documentary primarily features interviews with low-income individuals sharing their experiences with poverty and with receiving help. The struggles are highlighted through the painful awareness of poverty as embodied presence in Singapore. The wide coverage of the campaign in mainstream media, resulting in over 13 stories, and a newspaper issue dedicated to poverty disrupted the erasure. Voices of participants, positioned as interpreters of poverty circulated through news stories and digital narratives, anchored the conversation on poverty in Singapore.
As noted earlier, the NSLB campaign tested the commitment of the research team, embodying various forms of risks throughout the cycle of the campaign. From facing specific directives regarding the campaign to being interrogated for it, we negotiated the structural impediments to voice through commitment. Whereas, pragmatism might guide us to be strategic as we were told to “study poverty somewhere else,” commitment meant sticking to the course. Whereas, pragmatism might have guided us toward giving up on the public campaign and seek “closed door meetings to share our findings” as we were often instructed to do, commitment translated into staying with the objectives of the project in building communicative infrastructures. The interplay of solidarity and commitment rested on authenticity, as we continually asked as a research team what our values are, what does it mean to embody these values, and what does it mean for erased subaltern voices to be heard.
“Respect Our Rights” and Disruptive Narratives
The “Respect our Rights” is a campaign for domestic workers by domestic workers in Singapore. The campaign adopted the theoretical frameworks of the culture-centered approach and the process of radical participatory communication practices in constructing communicative techniques that sought to disrupt the hegemonic narrative of domestic work. The hegemonic narrative that dominates the discourse on migrant domestic work in the cosmopole is entrenched in the idea that the transnational flow of labor creates sustainable employment opportunities for those residing in the peripheries of global capital (Dutta and Kaur-Gill, 2018). Such ideological hegemons debar and silence narratives that inform the plight of the subaltern migrant worker (Bernardino-Costa, 2011) residing in the margins of the cosmopole.
The “Respect our Rights” campaign was targeted at disrupting the status quo discourse that peripheral migrant workers exist in dignity in these global city centers. Adopting Singapore as a case study, domestic workers residing here face key structural disadvantages that infringe on their labor, human, and health rights (Dutta et al., 2018). The nature of the hire of migrant domestic workers locally creates replete opportunities for abuse (Huang and Yeoh, 2007). In detailing the key narrative of the “Respect our Rights” campaign through participatory openings, domestic workers highlighted health rights as violated when their contracts were not obligated by employers. Their voices disrupted the dominant position that most migrant domestic workers were “satisfied with their work conditions” (Ministry of Manpower, 2015, p. 3) and structural processes were in place in protecting the rights of workers (Channel News Asia, 2017). Structural actors in the context of domestic work refer to gaps in the system that allow for the exploitation of domestic workers.
A key actor includes an errant agent that partakes in contract substitution during hire and post-hire. These agents may also typically deprive key communicative infrastructures to workers, such as not providing them with information about their labor rights, not translating or reading the contract to the domestic worker during hire, and failing to provide helpline services such as the contact details of the Ministry of Manpower Singapore, an emergency hotline or a local non-governmental organization contact in situations of distress. At a policy level, workers are not covered in the local employment act, thus limiting opportunities for due process in situations of mismanagement by employers. These gaps leave workers vulnerable to exploitative circumstances.
In conducting formative research, a key strategy of the “Respect our Rights” campaign was in positioning disruptive narratives that created spaces for alternative discourse on migrant worker rights to emerge. Workers highlighted how their health rights were tied to their human and labor rights as workers. These narratives were thematized systematically by workers and researchers before documenting them in the form of short television advertisements and newspaper advertisements. The media material created for the campaign highlighted the conditions of domestic work that could entail a lack of sleep from overwork, little access to sufficient food, contract substitution, physical, verbal and sometimes, sexual abuse, and receiving incorrect or no wages for their work. These storied realities centered on the key message of the campaign to local employers to respect the basic rights of domestic workers (Dutta and Kaur, 2016).
The configuring of the disruptive message was just as salient as the channels highlighted to distribute these messages. Our participants identified the key target audience as employers and strategically inquired into the kinds of channels local employers engaged in. “Respect our Rights” media material were then distributed along these channels as an intervention strategy. Between 2013 and 2018, the “Respect Our Rights” campaign already had three iterations, all with different embodiments of risk. The advisory board for the third round of the campaign was made up mostly of Burmese domestic workers who, arguably, are the most marginalized among the domestic workers, mostly because of linguistic and cultural differences, because of the age at which they arrive in Singapore, and because of the high likelihood of trafficking. They voiced out how they wanted to be treated as humans, just like everybody else, articulating stories of abuse. For this iteration, they wanted to communicate with fellow Burmese domestic workers as they felt that many of their peers are unaware of their human rights and have no way to find out about their rights, as well as speak about atrocities they experience to the “general Singapore public.” A few meetings and other FDW nationals filtered out, and what was left was an all-Burmese advisory board, with the conversations held in Burmese with the support of a bilingual community researcher. They felt strongly about the message of human rights; they also wanted to use social media and face-to-face peer campaigning.
The domestic workers brainstormed the content and the CARE team went back and forth with the materials with them. After the FDWs created, edited, and finalized the campaign collaterals, the partner organization (a local NGO in Singapore that does migrant worker advocacy) did not like it, because a new board felt the campaign was too bold and “on your face.” It was a major setback and one that went through deep discussion within the team whether to push through with the campaign or not. In the end, the team worked with the advisory board of domestic workers, staying faithful to the voices of the Burmese FDWs and what they wanted to communicate. This round of the campaign had the highest engagement amongst the materials produced by the team. Majority of those who interacted are FDWs from various nationalities. Many shared how the videos resonated with their lived experiences, and voiced their stories. Committing to sustaining the voice infrastructures meant that the campaign continued in spite of the withdrawal of the NGO partner. Authenticity as a methodological anchor meant that the voice infrastructures were accountable to the meanings held by subaltern Burmese domestic workers. This is critical in the context of Singapore where authoritarian state control translates into a civil society that serves as a mediator, often negotiating with the state through undemocratic behind-closed-doors negotiations anchored in “saving face.” In an elite culture where “saving face” among the elite translates into the censorship of civil society articulations along aesthetic guidelines palatable to the state and where worker protections are secured by the elite through closed-door negotiations, the campaign disrupted the paternalism through its commitment to communicative equality. Authenticity formed the basis of the solidarity with the subaltern advisory board members, which in turn, served as the basis for embodied actions, building networks of interventions created by FDWs.
The “Respect our Rights” campaign remains a key intervention that adopted culture-centered participatory strategies to support the crux of designing culture-centered campaigns, where agentic possibilities are realized by disenfranchised communities through their ownership of decision-making processes. In campaign design, the centering of community voice in every step of the decision-making process forms the first step toward communicative equality, as the basis for ongoing subaltern struggles for voice in the discursive space. The themes of commitment, authenticity, and solidarity play out throughout the various structures, spaces, and processes of decision-making, fundamentally dismantling the communicative inequalities that form the discursive infrastructures around domestic work. Commitment constitutes the architecture of the intervention that disrupts the structure and its curated/censored storytelling strategies, embodying health in claims to justice.
“Stiletto Project” and De-centering Structures
While there is high visibility of LGBT communities in Singapore, transgender8 persons comprise a small, marginalized portion of the community, an even smaller proportion of which tend to go into sex work at a young age amidst various structural, socioeconomic and cultural factors. The health of transgender sex workers (TSWs) in Singapore is overlooked, misunderstood and erased by health structures, where there is little to no participation in health policies and processes. Singapore's health authorities, the Ministry of Health and its statutory board, Health Promotion Board, take an approach that simultaneously medicalizes and erases the TSW community in its identification and categorization as ‘Men Having Sex with Men' or MSM, a population defined by its vulnerability to sexually transmitted infections such as HIV/AIDS, amongst others. The stigmas and intertwined structural violence constitute the everyday negotiations of sex work amid an authoritarian structure that continues to criminalize sex outside of strict heteronormative forms. In this backdrop of the erasure of the voices of TSWs, our culture-centered collaboration sought to build a communicative infrastructures where TSWs articulate, implement, and circulate a research agenda, constituted specifically in the context of advocacy. Our ethnographic collaboration with TSWs organized under the umbrella of Project X resulted in a collaborative research project, communication intervention, advocacy campaign addressing stigma, a white paper, and a digital infrastructure owned, controlled, and run by TSWs.
Project X, a sex worker advocacy and support organization, has documented issues faced in the transgender sex worker communities with which they work, who are often of low-income status, face barriers to education, from minority ethnic groups, caregivers and breadwinners, and face discrimination and violence in their everyday lives from the police, public housing officials, healthcare professionals, members of the public, clients, intimate partners, and their own family members (Ho et al., 2015). With these vulnerabilities come exacerbated health insecurities for transgender women in Singapore. Concomitant with the impacts of global trends of transphobia, transgender sex workers in Singapore seem to be at high risk of mental health issues, where they may have ideated, attempted or completed suicide or engaged in other types of self-harm, especially those exposed to higher levels of violence, discrimination and instability, and may experience social stress or anxiety disorders such as post-traumatic stress disorder (PTSD) (Lawrence, 2007; Meyer and Northridge, 2007; Bowen and Murshid, 2016).
In collaboration with Project X, our team worked with advisory boards of 10 TSW community members, peer leaders and transgender researchers over 30 meetings to form the Stiletto Alliance, or the Stiletto Project. These meetings were aimed at brainstorming, and designing culturally centered health communication collaterals for community members focused on self-empowerment and financial security, social support including coping with stress and stigma, accessing hormone therapy and gender affirming surgeries. Inverting the hegemonic framing of HIV/AIDS as the anchor to transgender health, central to the intervention infrastructure was the addressing of structural contexts of TSW health, disseminating information among TSW to foreground the role of structures, and from this information-based solidarity, develop collective efforts at addressing the structural contexts of health such as housing, stigma, policing, access to education, and access to income representation.
In many of the advisory board meetings, the community members would articulate going strongly with the messages of the campaigns. They were also very clear with their target audiences, first is to educate and raise awareness among peers; second, to educate the public about the stigmas attached to transgender sex work. Both stages demanded immense solidarity from the team. In many stages of the project, we received questions regarding administrative decisions related to the project. For example, we faced a lot of setbacks with engaging and hiring peer leaders, giving them access to university resources, securing spaces for them, and hiring them as community researchers on our projects. In an audit, one of us was asked why CARE hired a human rights activist (referring to one of our transgender sex worker community researchers) as a community researcher.
Identifying the representation of TSWs in mainstream media and public discourse as the site of threatening TSW health, advisory group members sought to develop infrastructures for voice that explicitly addressed their erasure. They identified media advocacy as a strategy for inverting the erasure, and for creating the bases for transforming structures. The advisory group engaged in scripting, storyboarding, acting and co-directing video advertisements targeted at members of the public as well as policymakers through digital spaces such as Facebook and Youtube. The advisory board members focused their ideas on three themes: police harassment of transgender sex workers, discrimination against transgender sex workers in public, and transgender rights. Through a deliberative decision-making process, they developed the “Adapt. Accept. Respect” Campaign, with the messages (a) “If you don't discriminate against race and religion, don't discriminate against transgenders.”; (b) “We are transgenders”; (c) “We are human.” These messages worked to call the public to change their attitudes toward transgenders, and recognize the not-so-radical notion that transgender people were human too. The second message recalled Singapore's national pledge, “We, the citizens of Singapore,/pledge ourselves as one united people,/regardless of race, language or religion,” adding transgender to this appeal to mainstream national and cultural values of equality for all citizens.
They interweave the language of minority rights with the language of neoliberal citizenship, and pose the question of deservedness: if transgender sex workers are hardworking, tax paying Singaporeans too, should they not deserve equal recognition? One video forewarned of the significant impacts of such stigma and discrimination against TSWs in Singapore and Malaysia: low self-esteem, depression, suicide, public violence, and even death; the other celebrated transgender sex workers as strong, proud and standing in power. What is critical to the intervention is its disruption of the state-sponsored structures imposed on representation of TSWs. Despite barriers to engaging in a national television commercial campaign (the Infocomm Media Development Authority in Singapore restricts “[f]ilms that…promote or justify a homosexual lifestyle”), the videos were released on digital platforms (Facebook and Youtube) through advertisements and a white paper, generating 245,000 views, 300 comments, and over 500 shares altogether over a 5 month period. The digital infrastructure “Stiletto Alliance,” liked by 1570 followers, is owned and run by TSWs, building a sustainable basis for structurally transformative messages, depicting the themes of commitment, and authenticity articulated earlier.
Embodied critical praxis emerges in the project in actively articulating a gender rights discourse in the context of an authoritarian regime where expert scholarship has appealed to culture to precisely erase the conversation on rights. Hegemonic forms of scholarship emerging from elite spaces within Singapore point to the impossibility of a rights language, instead promoting concepts such as accommodation, illiberal pragmatism, and collaboration. The argument goes somewhat like this; the language of rights is West-centric, and what is therefore needed for social change to work in Singapore is a form of pragmatism that accommodates to Singapore's unique illiberalism. In the voices of our collaborators, this language of accommodation keeps power structures intact, failing to transform the structures and keeping power in the hands of elite ventriloquists with access to power. As noted by Chitra, one of our advisory group members who participated in designing the intervention, “Fuck anyone that says human rights language does not work in Singapore. We take the risks of speaking up knowing that these are our human rights. We don't want anyone to come and say, human rights does not work in Singapore.” In our solidarity, we share and bear the risks of embodied struggles for democratic infrastructures (and are targeted for doing so, as noted in an excerpt earlier), constituted amid the various threats to speaking up amid powerful institutional, societal, and state-dictated structures of silencing.
Farmer Suicides and Public Health
Situated in the theoretical framework of the Culture-Centered Approach (CCA), this intervention deployed voices of the structurally disenfranchised farmer widows as a tool for interrogating, firstly the dominant development narrative of high-yield technology-driven agriculture, and secondly the psychosocial and psychiatric approach to mental health initiatives in the marginalized settings. The individual-centric care provided in these approaches discounts the structural inequalities experienced by the farming communities. The counseling and mental health awareness programs specifically targeting farmers in stress run by local Non-Governmental Organizations and the state government underway in Maharashtra by training human resources, aiming to prevent psycho-social distress, and management of mental health disorders by delivering community-based mental-health interventions, through projects such as VISHRAM (Vidarbha Stress and Health Program) in the Vidarbha region, Prakriti in Amaravati, and a project by Watershed Organization Trust in Wardha with technical expertise in Wardha (31 January, Pal, 2017) are offset by the narratives of the farmer widows. Disrupting hegemonic health communication narratives that parochially construct communication as messages and meanings constituted around health practices and in health settings, the overarching commitment of the project to listen to the voices of widows amid the agrarian epidemic embodies risk through its very disruption of the framing of health (as provider-patient interaction, eating five servings of fruits and vegetables, exercising, safe sex etc.) amid structures of Whiteness.
This project involved ethnographic fieldwork among the widows of farmers who have committed suicides amid the agrarian crisis unfolding in India. Voices of the farmer-widows were the central tool for interrogating the dominant development narrative of high yield, biotechnology-driven agrarian transformation that has replaced the indigenous farming systems (Rastogi and Dutta, 2015). Farmer suicides are constituted amid large debts taken by farmers from private sources for high interest rates to support the investment-intensive Bt cotton farming (Vasavi, 2012). The expensive seeds, fertilizers, pesticides are bought from the privately owned farming-inputs shops based on the advice given to the farmers by the input dealers. Yet crop failures are common in the drought prone region of Vidarbha, the eastern part of the state of Maharashtra that is mainly known for cotton production. Untimely rain or dry spells and unpredictability of changing monsoon patterns in the recent years add to the challenges that poor farmers face. In spite of the promise of the genetically modified cotton, pest attacks and crop diseases are widespread. In absence of input subsidies, guaranteed price for cotton produce that would earn the farmer a margin above the investments he made, and middle-men who buy the farmers' produce for cheap and sell for high profit margins has driven the poor farmer to indebtedness and loss of hope (Vasavi, 2012; Rastogi and Dutta, 2015).
In the backdrop of neoliberal reforms of the Indian economy that enabled the entry of transnational corporations into the Indian agriculture, replacing indigenous farming systems and commercializing agricultural input-output system, voices of the farmer-widows center the subaltern agency in foregrounding the meanings of farmer-suicides, and the stress borne by widows after the suicides. Through the voices of the widows, this project brought forth the narratives of neoliberal, patriarchal structures of agriculture that ties the respectability of the men in the households to their ability to provide for their families and pushes the male members of the family into alcoholism, gambling, and ultimately suicide by consuming pesticides or jumping into the well in their own farms. The narratives speak of extreme stress of indebtedness, worries about children's education and marriages, and feeding the family daily, while the farmlands remain dry and cotton crop fails after a whole year's labor and investment.
While suicides are committed by the male members of the farming households, the mediated discourse gives disproportionately less attention to the widows of the farmers. The narratives of the widows in this project centered the gendered subaltern who survives the death of her husband and faces the stigma of widowhood in the patriarchal rural structures. The money-lending structures exclude widowed women who are seen as having less ability than male members to repay the debts. The bureaucratic structures often remain inaccessible to the widows without a male accompaniment. The financial decisions of the household fall on the widowed woman who was earlier excluded from these decisions in patriarchal make-up of households. The extreme stress of keeping children alive, earning a livelihood for the household amid the highly laborious yet uncertain agriculture exerts stress on the widowed women who confess to having suicidal thoughts but prevent themselves from taking the step due to concern for their children.
These narratives are embedded in the cultural fabric of the rural, agrarian structures, while working collectively to offer universal anchors for structural transformation. Voice, within the CCA is embedded in the structural inequalities experienced culturally by marginalized populations (Dutta, 2008, 2011), and in the centering of subaltern agency as collective bases for change, offers collective imaginaries that disrupt neoliberal capitalist co-optation of agriculture (Thaker and Dutta, 2016). This imaginary of resistance is grounded in the actual work of generating knowledge that disrupts the knowledge claims, techno-deterministic solutions, and frameworks offered by transnational agro-capital. Our ongoing partnership with women farmers organized into cooperatives or sanghams under the umbrella of the Deccan Development Society (DDS) voices subaltern knowledge as the basis for universal transformation of agriculture (Dutta and Thaker, 2019). For instance, the concept of seed sovereignty emerges from the collective organizing of subaltern women, placing forth the knowledge that seeds are collective and community resources for health and well-being, owned by communities where the knowledge of growing seeds is located, and therefore, in resistance to the privatization of seeds for profit. The articulation of seed sovereignty is the basis for conceptualizing a sustainable ecosystem where food owned by communities through community-based practices is the basis for health.
The colonization of agricultural knowledge, practices, and resources of the poor farmers has transpired through joining of hands of multiple global and local elites, even producing consensus among the farmers themselves in favor of biotechnology-driven transformation in agriculture (Shah, 2005). Juxtaposed against the discourse of technology-driven agricultural development were the lived experiences of the grieving widows whose living conditions witnessed in their voices, and whose narratives of loss, hopelessness, and struggle for survival formed the basis of the listening infrastructures. These listening infrastructures disrupted our own city-swelling, upper class, upper caste bodies, located in the elite institution of knowledge building in Asia's knowledge capital. Our embodied privileges are juxtaposed in the backdrop of living conditions of perpetual hunger and indebtedness, incurred from previous farming cycles. As we witnessed the profit-making agendas of private inputs shops in Yavatmal, which also send vehicles to the surrounding villages to advertise the pesticides and other plant medicines that usurp the labor and resources of the small farmers for profit, and then act as the sources of credit for the farmers, our interrogations turned to the questions of the nature of communicative infrastructures we could co-create.
The absence of and limitations of the institutional support to the small farmers prior to and after farmer suicides was evident in the struggles that widows faced. Being situated within the structures of power that reproduce the hegemonic discourse of development in agriculture, our journey was filled with the emotional labor of listening and witnessing, foregrounding the narratives of the widows from intersections of the farming community to create spaces for narratives of failure of the dominant development model to be heard within those dominant structures. The fieldwork itself posed the challenge of being perceived as someone who perhaps works for the government or a private company, who could offer some immediate relief to the widows. This was a recurring moment of awareness about our positions within the structures of power while simultaneously struggling to foreground the cognitive legitimacy of the agrarian crisis as a health crisis. As health communication researchers, positioning suicides as fundamentally about health poses embodied risks amid the Whiteness of a discipline that parochially constructs health as individual behavior or as explicitly articulated health texts to be analyzed. Reviewers of submissions, including reviewers demonstrating commitment to the critical cultural paradigm, often noted that suicides have nothing to do with health communication, suggesting we submit our manuscript to sociology and anthropology journals. That each submission we make to health journals returns with rejections, with comments about the irrelevance of suicides and agrarian crisis to health depicts the Whiteness amid which this scholarship is placed and that it resists. The precarity one of us experiences as a junior academic is multiplied by the challenges of doing social justice work as anchor to health and communication, especially amidst the colonization of the critical health communication space by disembodied scholarship that demands abstractions.
Critical health method as embodiment here transforms into the body of the academic in solidarity with subaltern social movements imagining ecologies and farming systems that offer alternative pathways for health, healing, and wellbeing. The “doing” of agriculture as a collaborative practice that is imagined through subaltern knowledge re-works the large-scale capitalist co-optation of agriculture. The work of the Millet Network in placing millet as a sustainable crop and as the basis of health (of the human body as well as the ecosystem) works through embodied partnerships (Thaker and Dutta, 2016), with the everyday work of academics in the middle classes in interrogating academic privilege to generate knowledge claims from the global South, particularly from indigenous communities in the global South.
The call to cultural centering as a critical method is based in a commitment to global transformation. The values thus developed in culture-centered activist interventions, although specific to the local struggles that they develop in the context of, are universal in their transformative call. In fact, they de-construct the turn to culture as evident in the cultural sensitivity approach (Dutta, 2007), depicting the ways in which culture is incorporated into hegemonic interventions to consolidate and reproduce power. The acknowledgment that meanings of health form the basis for imagining communicative infrastructures for achieving health interrogates the dominant approach to health communication that unfortunately and stubbornly so, focuses on the reductionist, individualized, and parochial framing of health (Dutta, 2005). Embodiment as critical health communication therefore we argue, forms the heart of interventions into the disciplinary, depicting the urgency for aligning our loyalties with a transformative politics that works alongside class politics, collective organizing, dissent, and subaltern resistance to neocolonial extraction.
Transforming the Discipline
Turning to subaltern communities to ask, “What does health mean to you?” as our fundamental starting point, and then working from this starting point to build health communication/advocacy/activism means that our work embodied the ongoing risk of not being publication-friendly to the hegemonic norms of health communication, including paradoxically, the domains of critical health communication colonized by textual analyses and grotesque abstractions. The struggles for subaltern voice render visible the limits to the register of the text. Subaltern voices, in their understanding of health amid structures, ecologies, capitalism, threats to human rights, implode ontological categories that disrupt the dominant assumptions that inundate the disciplined terrains of health communication in the global North (we therefore are continually challenged with the question, “What is health in this?” which is fundamentally Eurocentric in its parochial understanding of health). These voices invite us to the possibilities opened up by bodily insertions into relationships of solidarity with subaltern struggles, challenging the superficiality of extractive texts that turn solidarity into a footnote, conclusion, or textual insertion. Subaltern voices in our work, embodied in interactions and relationships, thus threaten to dismantle the body of health communication scholarship, turning our struggles into embodied resistance.
Part of our embodied resistance through the struggles for voice is the interrogation of our practices as health communication scholars (thus participating in the methods of health communication), albeit at different locations and in different positions of social, economic, and political power within the academe. In an audit, one of us was asked, “what does health have to do with human rights?” While one of us is a Full Professor, others are mid-level academics with job security, others are in precarious academic positions, yet others are junior academics seeking academic homes, and some others who have had to quit academe altogether amidst ongoing struggles. The precarity of some of our positions is tied to the explicit diktat issued by the structure to steer clear of social change communication and in other instances, to cleanse the spaces we occupy of social change. The risk of turning to the messy politics of subaltern voice is embodied for a number of us then in our own negotiations of an academic home and finding a place that would sustain us in the academe, negotiating the question “What defines the health communication scholar?” Moreover, the slowness of embodied solidarities often calls for greater labor and attention that is placed on the everyday organizing and the politics of interrogating structures in an increasingly neoliberal university, driven by neocolonial rankings system originating from/in the West/North.
From our positions outside of the circuits of the global North then, the praxis of critical health communication is the everyday resistance work necessary to transform the neoliberal university (Heath and Burdon, 2013; Chatterjee and Maira, 2014). Embodied resistance teaches us to interrogate the politics of the very spaces we inhabit, and the ways in which subalternity is created everyday in these spaces. Our practices of solidarity with subaltern struggles for voice has taught us the vitality of solidarity when scholars are targeted and disciplined by the structures of the neoliberal university. Embodied criticality therefore for us is participation in dissent and lending solidarity to dissent that challenges the consolidation of power through authoritarian, state-managed, and corporate techniques. Embodied criticality is the re-organizing of universities as institutional structures. Through the creation of spaces and economic structures for community researchers, community organizers, activists in the university, the method of cultural centering performs embodied criticality, thus often inviting techniques of disciplining under the logics of accounting and management. When our TSW partners or our foreign domestic worker partners occupy places in the university with us, working together as researchers, the norms of institutions are disrupted, leading to various forms of abuse. Culture-centered work sensitizes us to the significance of transforming these spaces that we inhabit every day. We recognize the struggles of janitorial staff, cleaners, and maintenance workers as sites of critical health communication praxis. Ultimately, the embodied turn to culture-centered method suggests the recognition of the urgency of change in universities as the very spaces we inhabit through dissent, agitation, and the placing of the body in the frontlines of struggle.
Their universal appeal as the basis of knowledge claims forms the basis of culturally situated articulations that seek structural transformation (see Dutta, 2008). The recognition of the cultural nature of science and health knowledge, universalized in colonial interactions with the margins, forms the basis of recognizing the universalizing bases of culturally situated knowledge claims. The move-ment from the local to the universal mirrors the embodied movement of the critical health scholar from the margins to the center and back to the margins, through contingent and dynamic relationships with communities at the margins. This movement however is constituted in an active politics of transforming structures, challenging the very impediments established by the structures that actively erase subaltern voices.
The challenges of communication and health therefore lie in fundamentally transforming the structures that constitute the inequalities and ecological risks to health. That these structures can't be changed through incremental knowledge-based health communication solutions or simplistic behavior change solutions is itself a site of structural transformation. The hegemonic health organizations from the World Health Organization to the Centers for Disease Control and Prevention to UNICEF to USAID shape the health agenda through the interventions and communication solutions they sponsor. Based on the CCA for instance, the ongoing collaborations with women farmers in India identify the pressing public health concerns among farming communities in India besides the predominantly discussed suicides of the agriculturalists. Foregrounding the meanings of the public health concerns among the farming community puts forth an embodied politics of change that is fundamentally tied to reworking the politics of food, agriculture, and the ecosystem.
How critical health communication researchers collaborate with subaltern communities is also tied to actively imagining movements, collective bargaining, and political possibilities that transform structures. That the incremental addition to structures very much keeps structures intact re-focuses the work of the CCA on communication activism for changing structures. Structures therefore are contested, confronted by the participation of communities, with social change processes offering formations that anchor socialist health structures committed to equality.
Building Voice Democracies
By listening to the voices of the subaltern communities, the CCA seeks to construct knowledge from within, interrogating the hegemonic approach to health communication that enables dissemination of development interventions for modernization. Subaltern voices depict the possibilities of democracy that are worked out through everyday forms of participation that challenge the hegemonic constructions of health (Rall, 2018). The recognition that voice forms the heart of structural transformation also means that the work of cultural centering commits to building infrastructures for subaltern voices. The dominant structure reproduces itself by erasing subaltern voices; therefore, when the subaltern voices speak, the dominant structure works actively to erase it. Therefore, embodied health communication scholarship places the body of the academic as a method for critiquing the structure through the presence of subaltern voice. Here, solidarity and authenticity are integral to ensuring that the academic stays with the process of building infrastructures amid threats to the academic work, job security, and in other instances, health and life. Commitment sustains the ongoing work of building voice democracies so subaltern communities can participate in decision-making processes. Loyalty is not a theoretical construct in abstraction, but an embodied act that anchors our belongings in the project of dismantling neoliberal neocolonialism that fundamentally threatens the health and wellbeing of our species, ecosystems, and earth.
In conceptualizing critical health communication as embodied practice of resistance, we worked through ethnographic accounts of case studies that adopted the framework of the culture-centered approach to seek structural transformations. The body of the academic, crystallized through the concepts of commitment, solidarity, and authenticity is salient to the process of changing structures. We note that while often in critical scholarship, there are calls to changing structures at the end of pieces, the actual work of changing structures calls for an embodied practice that works through the academic body in imagining the possibilities of transformation. We also urge that the conversation on the CCA turn to the question of the commitments of our academic bodies to creating communicative equality within a larger project of building socialist infrastructures for health and well-being. In sum, we offer this account as an invitation to engage critically with our bodily formations as critical health communication scholars, asking: what does it mean to be doing critical health communication work?
Data Availability Statement
The datasets generated for this study are available on request to the corresponding author.
This study was carried out in accordance with the recommendations of the National University of Singapore Institutional Review Board with informed consent from all subjects. The protocol was approved by the National University of Singapore's Institutional Review Board.
Each author contributed to various aspects of the paper. Specifically, authors that lead the campaigns highlighted in various sections of the paper wrote about the campaigns in the paper. The first author directed the center, conceptualized, designed, and guided the implementation of the interventions reported in the manuscript.
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
3. ^Even as we voice these challenges, we recognize the contingency of these articulations amid potential threats of lawsuits, techniques of disciplining, and targeted campaigns. The newly introduced Protection of Online Falsehoods and Manipulation Act (POFMA) poses significant challenges of freedom of expression broadly and academic freedom specifically. One of us, Mohan Dutta, organized as part of a collective of academics, challenging POFMA.
4. ^How much we share, how we share, and how we voice our bodily struggles is constrained by the authoritarian structure of Singapore and the ways in which it scripts techniques of control over the body and its expressions of voice.
5. ^The concept of Marxism itself takes a peculiar turn in the context of Singapore, where the pro-colonial history of Singapore and the collaboration of the ruling People's Action Party (PAP) with the British rulers to fight Communism forms the bulwark of the national propaganda. In this backdrop, in 1987, civil society workers were labeled as Marxist conspirators and subjected to the draconian internal securities act (Barr, 2010). The narrative of the “Marxist conspiracy” works as a cautionary reminder of the risks attached to declaring Marxist attachments in Singapore.
6. ^We have anonymized the identities of the specific Ministries and other involved actors as strategic tools to protect ourselves from being sued, particularly so in the context of Singapore's new draconian law, Protection from online falsehoods (POFMA).
7. ^Y is a University administrator, whose identity here has been anonymized.
8. ^We use transgender as an umbrella term for persons who challenge gender normativity, which includes persons who identify as transfeminine, transmasculine, transsexual, hijra, genderqueer, female-to-male (FTM), male-to-female (MTF), intersex and more. In general, transgender refers to someone whose gender differs from that assigned at birth.
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Keywords: culture-centered interventions, critical methodology, solidarity, structural transformation, voices, activism, resistance, campaigns
Citation: Dutta M, Pandi AR, Zapata D, Mahtani R, Falnikar A, Tan N, Thaker J, Pitaloka D, Dutta U, Luk P and Sun K (2019) Critical Health Communication Method as Embodied Practice of Resistance: Culturally Centering Structural Transformation Through Struggle for Voice. Front. Commun. 4:67. doi: 10.3389/fcomm.2019.00067
Received: 30 April 2019; Accepted: 30 October 2019;
Published: 05 December 2019.
Edited by:Heather Zoller, University of Cincinnati, United States
Reviewed by:Mahuya Pal, University of South Florida, United States
Laura Lynn Ellingson, Santa Clara University, United States
Copyright © 2019 Dutta, Pandi, Zapata, Mahtani, Falnikar, Tan, Thaker, Pitaloka, Dutta, Luk and Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Mohan Dutta, email@example.com