Category Archives: Social Theory

Structuring structures constructed through historically structured structures: A.K.A. where Bourdieu’s ideas came from

“The past of social science is always one of the main obstacles to social science.”

– Pierre Bourdieu, Sociology in Question (1993)

Introduction:

In this semester’s classical social theory course Prof. John Stone remarked: “if nothing else, I hope that this course has given you a healthy skepticism of placing too much faith in social theory.” After closely reading classical theorists from Montesquieu to Veblen, I can see why: these thinkers and their grand ideas were products of their time and circumstance. In Postcolonial Thought and Social Theory, Prof. Julian Go makes a compelling argument for the problematic ontology and epistemology set out by classical theoreticians. They were often (in hindsight) obviously shaped by their cultural and historical moments and were therefor subject to their own biases and blind spots. More sociologically, we could say that these ideas were social productions of interested actors, most of whom were of privileged classes that increasingly deployed concepts to make sense of and manage threats to social order from below their ranks. In much of their research, early sociologists also tended to “reproduce the imperial gaze” by which empires operated, reproducing and reifying stereotypes and systems of power relations within and between social groups (Go, 2016, Chapter 2).

Sociology’s foundation was developed during the Enlightenment and rested on three central concepts: humanism, that there is a universal human nature that can be improved based on Reason; universalism, that the world is made up of basic unalterable truths that can be understood independent of space and time; and positivism, the reliance on scientific method as the best approach for understanding the world in general. This ontological way of knowing and epistemological lineage has come to shape how the discipline of sociology has evolved, leading Go and others to call for new social theory agenda that brings a subaltern (postcolonial) and relational perspective to understanding the social world.

Emerging from the elite intellectual community of France in the 1960’s, Pierre Bourdieu is one such relational sociologist. A giant of 20th century sociology, Bourdieu built a theory of social action based on field research ranging from kinship relationships in isolated villages in Algeria to the social processes of production, circulation, and consumption of art and literature in 19th century France. His work sought to bring “reflexive” sociological methods into building a whole understanding of social action: to “uncover the most profoundly buried structures of the various social worlds which constitute the social universe, as well as the ‘mechanisms’ which tend to ensure their reproduction and their transformation” (Bourdieu & Wacquant, 1992). Bourdieu’s work seeks to develop a way to understand the “buried” mechanisms that undergird social life and tend to create and reproduce dominance and domination in society.

Although Bourdieu’s perspective is by no means a “southern” theory—Bourdieu was born in southern France and ascended to the pinnacle of elite intelligentsia in the French academe—his work does, at first glance, appear to be a way to obliterate the antimonies and dichotomies that ontologically and epistemologically reproduce power relations through what he would call symbolic violence. In this way, he attempts to challenge and subsume some of the most pressing theoretical problems of classical social theory: the dilemma of structure vs. agency, the objective vs. subjective divide in epistemology, and the ontological problem of the individual or structural locus of agency.

In seeking to make this course not simply a philological exercise, my goal in this paper is to explore the classical theoretic roots of Bourdieu’s work. In doing so, I hope to assess whether he is successful in breaking with the “imperial episteme” and dissolving the age-old antimonies that bedevil social theory. Do Bourdieu’s “structuring structures” get up and out of the historically constructed and epistemologically limited structures of classical social theory?

Specifically, I seek answers to four broad sets of questions: 1) Who were the principal classical theorists referenced by Bourdieu (implicitly and explicitly)? 2) What ideas were most important in the formation of his theory of practice and social life? 3) How do these foundational concepts relate to Bourdieu’s ontology of the social and to his epistemological approach to social science? 4) Finally, given the problematic roots of classical social theory, does Bourdieu’s repackaging of classical ideas into a reflexive and relational sociology give us a “way out” of the colonial-epistemological bind?

I will start with a very brief background on Bourdieu’s biographical, educational, and historical context, then proceed to an explanation of his core theoretical concepts (field, capital, and habitus) and their applications, break down their most important conceptual linkages with classical social theorists, and then I will comment on their implications for Bourdieu’s epistemological project. I will conclude with an assessment of Bourdieu’s field-theoretic approach to relational sociology and its ability to emancipate social theory from the shackles of symbolic and historic violence.

Bourdieu’s Roots

Bourdieu’s biography matters only insofar as it helps to explain his internalized dispositions and socialized perspectives—his habitus, as he would put it. He began his journey being born in 1930 to a lower-middle class family in Deguin, a small town in the south of France. His father was the town postal worker and it was a fairly inauspicious start. This is important only in juxtaposition to the fact that he would rise to the pinnacle of French intellectual life.

More important than his early biography was his identification as a brilliant student who was able to gain entrance into École Normale Supérieure (ENS), one of the most prestigious universities in all of France. While there, he was able to study under the great structural Marxist, Louis Althusser, he had Jacques Darrida and Emmanuel Le Roy Ladurie as classmates, and was enveloped in classical and contemporary social theory and philosophy. He quick rose through the ranks of French intellectuals.

For these reasons, he would always feel like something of an outsider in the upper reaches of French society. This history and how it shaped his internal dispositions and priorities (habitus, which I will describe below) is important because it trained his focus on the ways that people (especially academics) shaped and defined the terms of debate, doing symbolic violence through dominating the ways knowledge was created. Loic Wacquant has an interesting perspective on this: “Back in 1981, he [Bourdieu] had seriously envisaged turning down the Chair in Sociology to which he was eventually elected at the Collège de France, the country’s top research institution, because he could not resolve to go through the official pageantry of the inaugural lecture. He assumed the position only after he had figured out how to turn the event onto itself and make it over into a performative paradigm for reflexive sociology by delivering a ‘Lecture on the Lecture’ in which he would dissect the social springs and underscore the symbolic arbitrariness of the very ‘rite of consecration’ he was enacting.” (Wacquant, 2013). Perhaps, because of his insider/outsider experience and the ways it shaped his own habitus, Bourdieu was hyper vigilant in identifying and exposing imbalances in symbolic power.

During this time, ENS served as a breeding ground for “young Durkheimians.” Indeed, he was able to carefully read, write on, and even began to lead lectures on Marx, Weber, and Durkheim while there. Additionally, he began to work closely with and was mentored by the illustrious sociologist, philosopher, and political scientist Raymond Aron as he launched his European Center for Historical Sociology. It was in this remarkable intellectual milieu that he began to form his ideas about the social world that would begin to take more formal shape while doing ethnography in Algeria (Swartz, 1997, 16).

Central to his philosophical development was his engagement with the tension animated primarily between two important French intellectuals: Jean Paul Sartre and Claude Levi-Strauss. These two academics embodied a confrontation of ideas—two extremes on an intellectual spectrum. Sartre was an engaged humanist and Levi-Strauss represented more of a detached scientist. As we will see, for Bourdieu, this tension proved fruitful and extended beyond just their styles of intellectual and scientific engagement, it also represented antithetical poles of basic opposition between subjectivism and objectivism in philosophy and social science. This would be a central focus for the future of Bourdieu’s scholarship (Brubaker, 1985).

Another important early philosophical influence was Gaston Bachelard who theorized on the philosophy of science in the midst of the scientific revolutions of the development of relativity theory and quantum mechanics. For Bachelard, “scientific knowledge is ‘constructed’ and ‘dialectical’ knowledge, one that does not arrive at final truths but proceeds as an ongoing project of correction and rectification of past errors” (Swartz, 1997, 31). He argues that in the face of radical scientific advances, the positivist philosophy of the past will not suffice and instead scientists must adopt a “dialectical reason”—an early example of “reflexive epistemology,” and a notion that Bourdieu would lean on heavily in trying to confront the productive tension between Sartre’s existential subjectivism and Levi-Strauss’s structuralism / objectivism.

Finally, as mentioned before, Marx, Weber, and Durkheim all played extremely important roles in shaping the contours of most of Bourdieu’s concepts and theoretical strategies. I will discuss their important contributions once I have sketched the key components of Bourdieu’s approach. As an aside (I will not be exploring these thinkers in this paper) theorists and philosphers such as Ausin, Cassirer, Heidegger, Husserl, Merleau-Ponty, and Wiggenstein also played somewhat important roles in shaping Bourdieu’s thinking (Swartz, 1997, 30).

Bourdieu’s Theoretical Apparatus:

We will start with a brief overview of Bourdieu’s key concepts that he developed over many years of teaching, fieldwork, systematic scholarship and engaging with some of the leading intellectuals of his age.

The concept of field brings a spatial / geographic element to Bourdieu’s theory of social practice. The field of social action is produced and reproduced by individuals and organizations that do not exist in a vacuum—they exist in relationship with one another. Individuals and organizations also compete with one another as they work in pursuit of shared aims, develop shared taken-for-granteds, grow shared interpretations, and fight over scarce resources. Loïc Wacquant offers a succinct definition: “a field is a patterned system of objective forces (much in the manner of a magnetic field), a relational configuration endowed with a specific gravity which it imposes on all objects and agents which enter it… Simultaneously, [it is] a space of conflict and competition, the analogy here being with a battlefield, in which participants vie to establish monopoly over the species of capital effective in it” (Bourdieu & Wacquant, 1992, 17). This social jostling and competition between actors in the field set up the terrain of a social game that is played out by social actors vying for dominance.

The habitus can be understood as an individual’s patterns of thoughts, behaviors, tastes, and actions acquired by their experienced participation in the social field of action. Bourdieu describes it as: “embodied history, internalized as a second nature and so forgotten as history—the active presence of the whole past of which it is the product.” (Bourdieu, 1990, 56).  Wacquant expands, “Cumulative exposure to certain social conditions instills in individuals an ensemble of durable and transposable dispositions that internalize the necessities of the extant social environment, inscribing inside the organism the patterned inertia and constraints of external reality… habitus is creative, inventive, but within the limits of its structures”. (Bourdieu & Wacquant, 1992, 13-19) The field of practice tends to produce individuals who have experienced and internalized the rules of the game as their habitus. Those individuals tend to then act in a way that reproduces the socially constructed field of practice, which, in turn, reinforces the internalized habitus of those in the field.

Finally, Bourdieu conceptualizes capital as multifaceted forms of field-specific power: economic, social, and symbolic. Economic capital is immediately transformable into money, but social capital (social relationships, friendships, partnerships), symbolic capital (prestige, clout), cultural capital (credentials, awards), and other forms of field-specific capital aren’t immediately transformable into financial resources. Non-economic forms of capital can be used to dominate fields of practice that organize society. Bourdieu compares each field to a market in which individuals and collective actors compete for the accumulation of the various forms of capital. In a field of practice, an agent with more capital will be successful over those actors with less capital (Ibid., 15). Again, Wacquant summarizes: “together, habitus and field designate bundles of relations. A field consists of a set of objective, historical relations between positions anchored in certain forms of power (or capital), while habitus consists of a set of historical relations ‘deposited’ within individual bodies in the form of mental and corporeal schemata of perception, appreciation, and action.” (Ibid., 16)

Bourdieu’s Classical Theory Roots

Bourdieu’s linked theoretical and empirical project has been one of the widest-ranging, diverse, and inventive since World War II. Publishing more than 25 books and 260 articles over a 40-year period, he did away with disciplinary boundaries and sought to tackle and reformulate some of the most challenging questions of the social sciences. Bourdieu stands out in his ability to draw from sociology, anthropology, history, linguistics, philosophy, political science, aesthetics, and literary studies and in his efforts to combine methodological approaches such as detailed ethnographic fieldwork, constructing statistical models, and abstract theoretical formulation. His work has been driven by a singular commitment to the idea that there could be a unified political economy of practice and that symbolic power could be understood in a way that could dissolve central social science puzzles: the challenge of analyzing micro and macro-level processes together, the difficulty of co-explaining social structure and the feeling of individual agency, and objective / subjective ways of interpreting meaning in the world (Bourdieu & Wacquant, 1992, 2-6). His goal is to build a truly “philosophical anthropology” in which social reality and ideas about human living would not just be built off of speculation and reflection on the universal attributes of humanity, but would be linked to a rigorous process of inquiry with the epistemic authority of scientific method (Peters, 2012).

Based on my readings of Bourdieu and a host of other books and articles dissecting his ideas and influences, I constructed the diagram below as a schematic of the ontological and epistemological roots of his core ideas. I have tried to demonstrate how various classical theorists’ ideas have served as building blocks and have been recombined to form Bourdieu’s central structuring structures. These theoretical constructs have given him the platform to systematically explore a wide variety of social phenomena empirically. My question then will be to assess whether he has truly constructed a theoretical base that can free social theory from the historical legacy of colonialism and symbolic domination.

Figure 1. Diagram of Bourdieu’s Influences and Theory

Synthetic Ontology

Bourdieu’s way of thinking about the nature of existence of the social world, his ontological vision, can best be described as synthetic, relational, and non-Cartesian. It “refuses to split subject and object, intention and cause, materiality and symbolic representation.” (Bourdieu & Wacquant, 1992, 5). Wacquant goes on:

“A total science of society must jettison both the mechanical structuralism which puts agents “on vacation” and the teleological individualism which recognizes people only in the truncated form of an “oversocialized ‘cultural dope’” or is in the guise of more or less sophisticated reincarnations of homo economicus. Objectivism and subjectivism, mechanicalism and finalism, structural necessity and individual agency are false antimonies. Each term of these paired opposites reinforces the other; all collude in obfuscating the anthropological truth in human practice.” (Bourdieu & Wacquant, 1992, 10).

One can see Bourdieu’s distain for artificial antimony throughout his work and his almost obsessive attempts to destroy these false divisions. Biographically and intellectually, it is possible to trace the roots of this obsession to his engagement with the intellectual battles between Jean-Paul Sartre and Claude Levi-Strauss and their followers who dominated much of the intellectual landscape in France in the wake of World War II. The tensions at the heart of this intellectual battle were philosophical/ontological, aesthetic/stylistic, and political.

Stylistically, Sartre represented the classic French “total intellectual”; he lived in such a way that he had complete alignment between his intellectual, scholarly, political, and practical engagements. As a public intellectual, he felt that he must “miss nothing of our time” (Swartz, 1997, 36). Conceptually, Sartre’s existentialism and subjectivism represented one distinct way of understanding social life: the carefree individual, creative and self-determining. Conversely, Levi-Strauss’ aesthetic was one of the professional academic, rather than the public-facing, politically active, celebrity-intellectual. His brand of causally-powerful social structures and formal view of the ways that social structures shape human thought could not be more in tension with Sartre’s (Swartz, 1997, 39-40).

This real-life, socially constructed rivalry and its effects in reifying an important antimony in the philosophy of human existence was an important shaping force for Bourdieu’s early thinking and his forming professional style and methodological commitments as well. It developed within him the motivation to try to build an understanding of the social world that was not simply about immutable social structures and sets of rules that govern the actions of social groups and could be measured in a statistically positivistic way. Nor was social life to be understood as the existentialists would have it: as a collection of individual agents freely floating through life with complete autonomy of spirit and freedom of will. As we will see, this tension filled relationship, and these polarized conceptual apparatuses, form a creative space which could very well be the roots of one of his most important conceptual tools: the habitus, as described previously.

In addition to Bourdieu’s formative encounter with the intellectual and stylistic dualisms of Sartre and Levi-Strauss, Bourdieu was also a close scholar of Marx, Weber, and Durkheim, and their formative ideas became very important, in different ways, to Bourdieu’s formulation of theory and method in understanding the social world. Sometimes scholars have viewed Bourdieu’s ideas as having been influenced by Weber, Durkheim, and Marx in equal proportion: a focus on the symbolic dimension from the first, a sociology of domination from the second, and an interest in class struggle from the third (Riley, 2015). However in my reading, Durkheim’s approach and work weighs most heavily in Bourdieu’s formulations of theory.

In particular, Durkheim’s understanding and description of the symbolic dimensions of social life and its power to effect social action was highly influential for Bourdieu. Although Bourdieu would distance himself from Durkheim’s highly positivistic method, statistically measuring patterns of variation in the social world (Durkheim, 1951), he would come to adopt and utilize the idea of “social facts as things.” Particularly key is Durkheim’s somewhat “neo-Kantian” epistemological approach, which we will come to soon (Robbins, 2003). Additionally, Durkheim’s view of understanding of the ways symbolic manipulation plays into social life is central in Bourdieu’s conceptions of less material forms of capital and the ways these forms of power can render symbolic domination within fields of struggle (Swartz, 1997, 46-48; Durkheim & Fields, 1995). He also came to identify with Durkheim’s style (as he tended to resonate stylistically with Levi-Strauss) and came to view sociology as a professional scientific discipline.

Max Weber’s thinking also loomed large in Bourdieu’s foundational ontology. Specifically, Weber’s tools to describe symbolic resources and practices were central to Bourdieu’s understanding of symbolic capital and domination (Swartz, 1997, 41). At the heart of understanding Bourdieu’s notion of field as a contested social space of material and symbolic domination is Weber’s “value spheres” (Bruun, 2008). For Weber, values spheres were linked to the philosophical triad of truth, morals, and culture: things we know, what we ought to do, and what we want to do. They were spaces or domains of social life governed by “inherent laws” pertaining to these fields or systems. These value spheres can be linked to Bourdieu’s fields as empirically identifiable spaces of social relations, historical periods, or geographical periods—not some settled systemic criterion (Ibid.). Although perhaps oversimplified, scholars have suggested that Bourdieu’s fields resemble quasi-Marxist Weberian value spheres. By “subjectivizing” Marxist thought with Durkheimian concerns with the forms and functions of symbols, and Weber’s work on symbols and their concrete power as well as a more formal structuralism, Bourdieu has attempted to unify some of the most frustrating divisions in social theoretical thought and advance a more fully-fledged ontological view on social life (Brubaker, 1985). 

Reflexive Epistemology

Where things become particularly interesting in is how these base-level ontological influences become recombined into Bourdieu’s conception of how we can come to know things about the social world. One aspect that makes Bourdieu so unique in my view is his seemingly complete and parsimonious view of the philosophical nature of social life and his practical methodological process of generating knowledge about its formation and function. At the same time, Bourdieu was pragmatic and his views evolved and morphed over the course of his studies. Throughout his career, Bourdieu was prepared to use whatever sociological explanations were to hand and which seemed to fit plausibly the historical, ethnographic records with which he was working (Robbins, 2003). By seeking to obliterate the distinctions dividing the existentialists from the structuralists and bringing together a synthesis of key concepts uniting the classical theorists, Bourdieu needed not just new ideas, terminology, and ways of thinking about social life. He needed a new of way of doing social science work. This is accomplished through linking his synthetic ontology with a highly reflexive epistemology of science and knowledge.

The keys to Bourdieu’s epistemology of the social are also at the roots of Durkheim’s thinking. Although as previously discussed, Bourdieu rejected Durkheim’s highly positivist philosophical leanings and methods, he embraced his “neo-Kantian” approach which brought in a phenomenological way to understanding the mind and subjective experience of people in social life (Ibid.). For Bourdieu, all social analysis involves the analysis of a system of relations within which individuals operate and through which their individualities are defined. At the same time, those producing social analysis are themselves embedded within a system of relations, which have a shaping effect on the researchers own perspectives, dispositions, resources, and opportunities. The fundamentally relational nature of social life and the correspondingly relational nature of the productive work of social analysis, demands a completely relational nature of knowing. Producing knowledge requires turning back on oneself, reversing the “scholarly gaze” to explore the system of relations and dispositions that shape the researcher and their approach to research. From Robbins:

“We know from Bourdieu’s later articulation of a reflexive methodology, involving conscious ‘epistemological breaks’, that he was as dissatisfied with an ethnomethodological approach that might suppose that phenomena could absolutely speak for themselves as he was with the detachment of structuralist objectivity. As a method of enquiry, Bourdieu’s ‘post-structuralism’ sought to integrate both aspirations, but it was also always the case that he saw his texts as products generated within a system of communication where meaning is constructed reciprocally in the way in which he had outlined in ‘Champ intellectuel et projet créateur’” (Robbins, 2007)

One important intellectual resource for Bourdieu in this formidable task was the work of Gaston Bachelard, French philosopher of knowledge and science during the early 20th century, who was referenced earlier. Bachelard’s non-positivist epistemological approach was starkly different from French sociologists at the time and it enabled Bourdieu to begin to imagine what a non-positivist, reflexive sociological epistemology could look like. For Bachelard, “scientific knowledge is ‘constructed’ and ‘dialectical’ knowledge, one that does not arrive at final truths but proceeds as an ongoing project of correction and rectification of past errors” (Swartz, 1997, 31). Sociolanalysis requires reflexivity, because knowledge must be communicated and legitimated in language and we are embedded in concrete social relations that produces that language.

Similar to Bachelard, Karl Mannheim presented Bourdieu with more theoretical resources for a non-positivist epistemology of science. For Mannheim, the sociology of knowledge (or Wissenssoziologie) attempts to analyze the relations between symbolic forms of knowledge and objective social structures. The idea of socially bounded knowledge implies a set of necessary assumptions: meaning/knowledge is organized according to certain structures, these structures take on “symbolic forms,” and that these symbolic forms are more often than not delineated by socio-economic or class membership (Kögler, 1997). Mannheim states: “Different social strata, then, do not ‘produce different systems of ideas’ {Weltanschauungen) in a crude, materialist sense—they ‘ produce ‘ them, rather, in a sense that social groups emerging within the social process are always in a position to project new directions of that ‘intentionality’, that vital tension, which accompanies all life” (Mannheim, 1921/1922).

Another resource for Bourdieu in developing notions of reflexive epistemology in the social sciences was the work of another anti-positivist, neo-Kantian: Georg Simmel. Simmel worked to develop a formal sociology defined by relations. For Simmel, all of social reality came from the form of social interactions, the content of these interactions, and the reciprocal influence that these interactions would have on individuals over time. For Simmel, one could not understand social phenomena without first beginning with small-scale interactions and the micro-level structural shape/form that they took (Simmel, 1895). Taken together, Bachelard, Mannheim, and Simmel describe neo-Kantian notions of the phenomenological alongside non-positivist, reflexive approaches to the sociological study of science. These thinkers paved the way and enabled Bourdieu to formulate a truly innovative way of generating situated knowledge about the social world that was thoroughly scientific while also relational with respect to the subjects and the researcher alike.

Unified Praxeology: Reflexivity of the Researcher + Relational Methodology

Bourdieu’s synthetic ontology—which collapsed old antimonies—set up the possibility of a truly reflexive epistemology: a way in which knowledge could be generated without resorting to positivistic, macro-level studies using statistical controls or falling back to philosophical hand-waving about the state of nature. Rigid theoreticism and methodologicism can now be done away with and a total science of the social can now be advanced. Agnostic to any one particular method, Bourdieu was freed to pursue modes of inquiry, data collection methods, and tools of analysis that fit the question at hand—both practically and philosophically.

This meant that a well-trained scientific habitus would need to be developed: social scientists need to think relationally, particularly while constructing their object of study (Bourdieu & Wacquant, 1992, 224-235). As would be assumed from a reflexive epistemology, there can be no separation between empirical “technical” choices and “theoretical” choices in the construction of the object of study. There must be unity between the hypotheses given by the existing literature, the theoretical presuppositions given by the existing evidence, and the theoretical-methodological choices made in trying to gather and interpret data / evidence about the given social phenomenon. What’s more, the positionality and relationship of the researcher to constructed object of interest must also be carefully taken in to account. Bourdieu explains:

“To construct a scientific object also demands that you take up an active and systematic posture vis-a-bis ‘facts.’ To break with empiricist passivity, which does little more than ratify the preconstructions of commons sense, without relapsing into the vacuous discourse of grand ‘theorizing,’ require not that you put forth grand and empty theoretical constructs but that you tackle a very concrete empirical case with the purpose of building a model (which need not take a mathematical or abstract form in order to be rigorous.)… Ordinary sociology, which bypasses the radical questioning of its own operations and of its own instruments of thinking, and which would no doubt consider such a reflexive intention the relic of a philosophic mentality, and thus a survival from a prescientific age, is thoroughly suffused with the object it claims to know, and which it cannot really know, because it does not know itself.” (Bourdieu & Wacquant, 1992, 236).

These epistemological breaks more often than not correspond to social breaks: with decorum, methodological purity, political norms, and group definitions. This is how Bourdieu has chosen to advance such a radically politically subversive social science agenda. Rather than serving as the total “public intellectual” a la Sartre or the completely politically dispassionate, positivistic social scientist such as Levi-Strauss, Bourdieu demonstrates the depth of symbolic power that the scholar can wield. By documenting the concrete relationships between actors in a field of practice, displaying the types and relative inequalities in ownership of different species of capital by those actors, and watching, over time, as those actors demonstrate dominance or submission in relationship to one another, a praxeological socio-analyst can uncover social realities previously obscured. Perhaps more importantly, by exposing these previously hidden social realities of dominance and submission, new modes of political action and activism are made thinkable and therefor possible.

Conclusion: Bourdieu as a way up and out?

I will conclude with an assessment of if and how Bourdieu’s work creates the opportunity for a truly liberating social theoretical approach. Does Bourdieu’s repackaging of classical ideas into a reflexive and relational sociology give us a “way out” of the colonial-epistemological bind?

As I discussed in the introduction, social theory is rooted in an ontology and has developed an epistemological approach that made imperialism understandable and justified. Auguste Comte first used the term “sociology” in 1839 to characterize “the social” distinct from political, economic, and religious realms. In practice though, it was a way of creating a new technical domain of elite social scientific researcher. Privileged classes have been able to use the technical understanding produced through sociology to manage threats to social order from below their ranks. As Julian Go describes, classical social theory could be looked at in juxtaposition to postcolonial thought, which is fundamentally anti-imperial and grew out of English and literature departments at the beginning of the 1980s. Writers such as Edward Said, Gayatri Spivak, and Homi Bhabha; historians including Ranajit Guha or Dipesh Chakrabarty; and anti-colonial theorists Frantz Fanon, Aimé Césaire, Amilcar Cabral, W. E. B. Du Bois, and C. L. R. James were central to these efforts. These writers, and others, sought to articulate a worldview and cultural analysis that rejected the humanist/positivist way of knowing the world. (Go, 2016).

Taking a Bourdieusian approach, we might ask: in what systems of relations were classical social theorists embedded? What types of risks and rewards—material and symbolic—were at stake in their lives and their work? Similarly, we might ask the same questions of the subaltern, southern-positioned, and post-colonial thinkers. What concrete sets of embedded relationships, forms of symbolic and material capital, and lived dispositions form the matrix of their decision-making and practice? Though I have not done this analysis, I can imagine the value. And, for me, this is why I would answer the fourth question I laid out in the introduction affirmatively. Using a relational, reflexive, Bourdieusian approach, we can actually approach these questions in systematic and rigorous way. Through constructing these questions as empirical objects of praxeological socioanalysis, we could imagine generating new knowledge about the situated nature of the production of knowledge, and to the power processes embedded within and reified by the network of actors responsible.

Bourdieu’s epistemological approach, alongside a pragmatic praxeological sociolanalysis, does in fact give us the theoretical leverage to overcome the colonial roots and symbolically violent forces of historically constructed classical social theory. Bourdieu’s work does not, however, give us answers. It does give us an alternative social scientific language necessary to ask different types of empirical questions. These empirical questions, when paired with a relational methodology and reflexive epistemology have the potential to split apart the deep structure of power and privilege to enable serious analysis. Whether or not this is a truly liberating approach will have to do with the courage and skill of the sociologists who attempt to deploy it. While it may be true that “the past of social science is always one of the main obstacles to social science,” Bourdieu’s work can help us to imagine a future social science that is at once more synthetic, unified, and critical.

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Kögler, H. H. (1997). Alienation as epistemological source: Reflexivity and social background after Mannheim and Bourdieu. Social Epistemology, 11(2), 141–164. http://doi.org/10.1080/02691729708578839

Montesquieu, C. D. (1949). The spirit of the laws. New York: Hafner Pub. Co.

Mannheim, K. ‘On the interpretation of Weltanschauung’ (1921/1922), in Mannheim, K., Essays on the Sociology of Knowledge, London: Routledge & Kegan Paul, 196

Marx, K., & McLellan, D. (2000). Karl Marx: selected writings. Oxford: Oxford University Press.

Peters, G. (2012). The Social as Heaven and Hell: Pierre Bourdieu’s Philosophical Anthropology. Journal for the Theory of Social Behaviour, 42(1), 63–86. http://doi.org/10.1111/j.1468-5914.2011.00477.x

Riley, D. (2015). The New Durkheim: Bourdieu and the State. Critical Historical Studies, (Fall), 261–279.

Robbins, D. (2003). Durkheim Through the Eyes of Bourdieu. Durkheimian Studies, 9(1), 23–39. http://doi.org/10.3167/136202403780788777

Robbins, D. (2007). Sociology as Reflexive Science: On Bourdieu’s Project. Theory, Culture & Society, 24(5), 77–98. http://doi.org/10.1177/0263276407081284

Shipman, A. (2004). Lauding the Leisure Class: Symbolic Content and Conspicuous Consumption. Review of Social Economy, 62(3), 277–289. http://doi.org/10.1080/0034676042000253909

Simmel, G. (1895). The problem of sociology. Philadelphia: American Academy of Political and Social Science.

Simon, R. M. (2011). Habitus and Utopia in Science:  Bourdieu, Mannheim, and the Role of Specialties in the Scientific Field. Studies in Sociology of Science, 2(1), 22–36. http://doi.org/10.3968/j.sss.1923018420110201.004

Swartz, D. (1997). Culture & power: The sociology of Pierre Bourdieu. Chicago: The University of Chicago Press.

Trigg, A. B. (2001). Veblen, Bourdieu, and Conspicuous Consumption. Journal of  Economic Issues, 35(1), 99–115. http://doi.org/10.2307/4227638

Wacquant, L. (2013). Bourdieu 1993: A Case Study in Scientific Consecration. Sociology, 47(1), 15–29. http://doi.org/10.1177/0038038512472588

Postcolonial thought: the emancipation of social theory?

postcolonial-thought-and-social-theorySome thoughts on: Go, Julian. Postcolonial Thought and Social Theory. New York, NY: Oxford University Press, 2016.

From the beginning, sociology has stylized itself as an emancipatory (or at least, progressive) social science (Burawoy, 2005). What then are we to do with the fact that the roots of sociological thought are built from ideas emanating from (if not outwardly praising) imperialism, colonialism, and domination of much of the world? This is the central question that Prof. Julian Go tries to tackle. He seeks to explore how this imperial context more precisely shaped the content of sociology and social theory— and whether it still does today. Does social theory bear the imprint of its imperial origins? Has social theory extricated itself from this earlier imperial entanglement?

This is a historical and theoretical challenge. Prof. Go spends the better part of the book tracing the classical social theory that underpins modern sociology as well as the countervailing postcolonial thought that emerged in the wake of decolonialization efforts throughout Asia and Africa. This historically grounded analysis of the actors and forces shaping social theory and postcolonial thought is based in conflict and division. Postcolonial thinking emerged as a result of the cultural and epistemological roots of social theory, and in opposition to it. Sociology largely accepts the notion that ideas are shaped by the social environments in which they are formed (Berger & Luckmann, 1966). For this reason, it is not hard to understand why the ways of knowing articulated via social theory and postcolonial thought are so radically different.

For Go, social theory is rooted in an ontology and has developed an epistemological approach that made imperialism understandable and justified. Auguste Comte first used the term “sociology” in 1839 to characterize “the social” distinct from political, economic, and religious realms. In practice though, it was a way of creating a new technical domain of elite social scientific researcher. Privileged classes have been able to use the technical understanding produced through sociology to manage threats to social order from below their ranks. Its foundational concepts were developed during the Enlightenment and rested on three central concepts: humanism, that there is a universal human nature that can be improved based on Reason; universalism, that the world is made up of basic unalterable truths that can be understood independent of space and time; and positivism, the reliance on scientific method as the best approach for understanding the world in general.

This is contrasted with postcolonial thought, which is fundamentally anti-imperial and grew out of English and literature departments at the beginning of the 1980s. Writers such as Edward Said, Gayatri Spivak, and Homi Bhabha; historians including Ranajit Guha or Dipesh Chakrabarty; and anti-colonial theorists Frantz Fanon, Aimé Césaire, Amilcar Cabral, W. E. B. Du Bois, and C. L. R. James were central to these efforts. These writers, and others, sought to articulate a worldview and cultural analysis that rejected the humanist/positivist way of knowing the world. As Go says, “Fanon saw in European humanism little else than a bourgeois narcissism projected onto the entire world— a world teeming, in the view of the Enlightenment, with ignorant hordes awaiting the salvation of European colonialism.” Because of the cultural and epistemological hold that social theory has had in the academy and society at large, postcolonial thought has been relegated to the humanities and literature departments. In fact, popular culture has, at times, paid more attention to postcolonial thinking and literature than has social science. Go writes that, “The New York Times has referred to Homi Bhabha more times than the American Sociological Review.” This enabled these thinkers, however, to direct their critiques to more than simple political domination and economic exploitation—it opened them to possibilities of emancipatory futures.

Is there an opportunity for reconciliation between these two modes of knowing? Or, does social theory need to be repealed and replaced? For Go, the opportunity comes from one other central concept of modern social theory: the notion that we must be reflexive about what we know and that our conceptions of reality are fundamentally socially constructed (Bourdieu & Wacquant, 1992). For this reason, we should be critical of the social, historical roots and political usage of social theory in modernity. If all knowledge is necessarily constructed in a situated time and place by embedded actors with concrete interests and concerns, the antagonistic nature of social theory/postcolonial thought is understandable given their roots within the dominant/dominated.

Go offers a compelling turn in search of reconciliation. By seeing the threads of social theory and postcolonial thinking as bifurcated, we necessarily occlude the nature of empire and the empirical project of understanding history and modernity. A true postcolonial social theory will need to be not solely an empirical project but also an epistemological one. It must be about “finding ways of knowing and thinking that escape the strictures of the imperial episteme.” His solution is relational sociology. Relationalism gives social theory a way of understanding the world in flux and can overcome social science’s tendency toward “analytic bifurcation, which in turn has perpetuated social theory’s persistent Orientalism, its occlusion of empire, and the repression of colonized agency from its accounts.” Field theory and actor network theory are good starting points for this new analytic and theoretic project. Subaltern ways of thinking and “southern theory” rooted in the ontologies and perspectives of people coming from marginalized positions is key.

In summary, Go’s Postcolonial Thought and Social Theory reads as a good review of the roots of two ways of knowing the world: legitimated social theory coming from elite oppressors and marginalized postcolonial thought rooted in an ontology of the “wretched of the earth.” While this book does an excellent job tracing and summarizing the core themes and history linking these two literatures, I wonder what is truly novel about this synthesis? Postcolonial relationalism linked with a subaltern standpoint seems like an important way of dissolving unnecessary bifurcations and occlusions in ways that can allow new insights into social realities, especially of the dominated. Yet, after having read the book, I am still left with the question of how, exactly, postcolonial thinking will be able to emancipate social theory from its problematic history and ontological roots.

Bourdieu, P., & Wacquant, L. J. (1992). An invitation to reflexive sociology. Chicago: University of Chicago Press.

Berger, P. L., & Luckmann, T. (1966). The social construction of reality: A treatise in the sociology of knowledge. Garden City, NY: Doubleday.

Burawoy, M. (2005). For Public Sociology 2004 Presidential Address. American Sociological Review, 70(February), 4–28. http://doi.org/10.1177/000312240507000102

NGOs: In the service of imperialism?

Just re-stumbled upon an oldie but a goodie paper, “NGOs: In the service of imperialism,” that is purposefully provocative about the purpose and function of NGOs in the global development and economic landscape. James Petras is a somewhat eccentric Marxist and this paper is a scathing critique of NGO action, even purportedly “rights based,” liberal NGOs working to “mobilize civil society” in the name of democracy and rights.

Similar to Monika Krause’s view of “the good project” 1 and the commodification of projects and beneficiaries, Petras see’s NGOs as serving the function of preventing or co-opting true, locally-driven movements to apply political pressure to governments and the international actors to protect rights.

“NGOs emphasize projects not movements; they “mobilize” people to produce at the margins not to struggle to control the basic means of production and wealth; they focus on the technical financial assistance aspects of projects not on structural conditions that shape the everyday lives of people.”

He goes on:

“The formal claims used by NGO directors to justify their position  — that they
fight poverty, inequality, etc. are self-serving and specious. There is a direct relation between the growth of NGOs and the decline of living standards: the proliferation of NGOs has not reduced structural unemployment, massive displacements of peasants, nor provided liveable wage levels for the growing army of informal workers. What NGOs have done, is provided a thin stratum of professionals with income in hard currency to escape the ravages of the neo-liberal economy that affects their country, people and to climb in the existing social class structure.

“By talking about “civil society” NGOers obscure the profound class divisions, class exploitation and class struggle that polarizes contemporary “civil society.” While analytically useless and obfuscating, the concept, “civil society” facilitates NGO collaboration with capi- talist interests that finance their institutes and allows them to orient their projects and followers into subordinate relations with the big business interests that direct the rico- liberal economies… In addition, not infrequently the NGOers’ civil society rhetoric is a ploy to attack comprehensive public programs and state institutions delivering social services. The NGOers side with big business’ “anti-statist” rhetoric (one in the name of “civil society” the other in the name of the “market”) to reallocate state resources. The capitalists’ “anti-Statism” is used to increase public funds to subsidize exports and financial bailouts, the NGOers try to grab a junior share via “subcontracts” to deliver inferior services to fewer recipients.”

I tend to agree with him about the structure of power and forces that shape the NGO terrain and ultimately drive the practice of NGO managers and the programs they develop. I think (as I’ve written) that these forces are often, if not always, antagonistic to the political process necessary to demanding the protection of rights, especially the right to health. Private NGOs seem to lessen the pressure on the public sector to provide fundamental social services (such as education and health care) and can function as a tool of privatization. Linking back to the comments by Dr. Salmaan Keshavjee about his experience with developing a revolving drug fund Kazakhstan with the Aga Khan Foundation, its easy to see how NGOs can function “transplantation device” for neoliberal, “free market” ideas and the privatization of fundamental social services.

At the end of this piece, Petras calls for a more robust “theory of NGOs.” I think there is a major opportunity to build off Bourdieu, McAdam, and Krause to develop better theoretical constructs and case study examples to analyze the expansion of transnational nongovernmental organizations and the ways they alter the local political, economic, and cultural landscape in poor and marginalized communities around the world. It seems clear that the “field” of international development has set up the game that NGOs play, the rules of which are dominated by large-scale capital. This is the game of the construction of commodified “good projects” that then get sold to the international financiers on an “open market.

The question for me is: what’s to be done?

Though I’m sure you can level all sorts of critiques at Partners In Health as a fairly large transnational NGO, I do believe there is something unique and special about the way that we have tried to institutionalize a practice of “accompaniment.” I believe that PIH has a stated and deeply held set of values, internal logics, and defined purpose that in many ways runs perpendicular to the animating logics of the “Bourdieusian” field of international development. PIH’s core purpose is to work alongside ministries of health and marginalized communities to build the capacities to develop high-quality health care delivery systems that can be scaled into national systems of universal health coverage. We seek to accompany governments in the process of helping them meet the obligations of protecting the rights of their citizens, of which we consider health to be foundational.

I have seen how the field-defining “good project” drives the flow of capital through financing mechanisms (bilateral foreign aid, in particular), and makes PIH’s core mission (and a more broadly important function in the world if we want to advance rights-based work) very difficult to finance. At least, it makes it nearly impossible for an organization attempting to support governments in the task of being effective in their work to deliver packages of needed services (thus, protecting rights) at scale to gain access to the capital necessary to do this work effectively.

Questions we need to keep working on:

  • What type of social movement or political project is necessary to sufficiently disrupt and reorient the field of international development such that it can be less organized towards the narrow construction of tightly defined projects and more towards the goal of enabling governments to be effective in protecting rights?
  • What would it take to reform the large-scale financing mechanisms that reflexively define “the good project” and are reinforced by this definition?
  • Could we imagine the creation of new financing mechanisms that would direct capital towards the idea of a “third sector organization” type that we might call an “accompaniment” organization? An accompaniment organization could be thought of as one that would be focused on the specific work of embedding in and enabling a public sector (government ministry) to be effective in its work to protect social/economic rights of citizens (health in particular, or at least for us).
  1.  Krause, Monika. The Good Project: Humanitarian Relief NGOs and the Fragmentation of Reason. Print. ↩

Theorizing on the emergence of university-based global health programs

A couple of years ago, some student volunteers and I embarked on a mini-research project to better understand the magnitude and time dynamics of the growth of university-based global health programs across the U.S.  You can find our posts and summary of our amateur findings here.

Personally, I’ve seen the remarkable growth and expansion of undergraduate-focused global health educational programs (new majors, minors, centers of interdisciplinary study, study abroad programs, etc) through my work with both GlobeMed and PIH Engage, and seeing the rapid expansion of the Global Health Corps and similar fellowship organizations over the past ten years. In fact, GlobeMed students and many others have been a catalyzing force urging administrators to develop new courses and programs of study.

Figure 5

Our attempt to measure the growth of undergraduate-focused global health program growth at U.S. universities.

Others have also commented and tried to characterize the fairly rapid and significant expansion of undergraduate-focused university-based global health training and educational programs. The Center for Strategic and International Studies has two solid reports, one from 2009 and another from 2014. A flurry of papers have also worked to characterize and have tried to understand the implications of this new focus in higher education. The Consortium of Universities for Global Health has emerged as a powerful force “sharing knowledge and best practices” across universities and colleges, especially between those in “resource rich and resource poor” countries. It seems clear that universities are important and powerful hubs of meaning-making, frame-setting, agenda developing, and training of powerful (or soon-to-be) actors in global health. The magnitude of U.S. universities’ role has grown significantly over the last decade and seems to be growing.

Despite all of this however, I have struggled to understand the drivers of these changes at the university level. Why are these programs being set up? Why are they growing in terms of students, faculty, and influence? What catalyzed this emergence and shift? I think that theorizing on and testing answers to those questions is an important step in understanding the “social movement” for the right to health. University-based global health programs are very important in understanding the full picture of the “field of practice” of global health that has emerged, especially since the emergence of the AIDS treatment movement.

Doing some google and database searching led me to the great dissertation and subsequent research of Karl Maton, a professor of sociology at The University of Syndey. Specifically, his dissertation titled, “The Field of Higher Education: A sociology of reproduction, transformation, change and the conditions of emergence for cultural studies” lays out a compelling theoretical construct that I think is very useful to understand the institutional practices of conservation and change within universities. His case is explores the structuring shifts that led to crises and realignments in English universities during the 1960’s that led to the emergence of “cultural studies” as a legitimized discipline.

His theoretical construct uses Pierre Bourdieu’s field, capital, and habitus (as I’ve tried to sketch in application for global health) in combination with Basil Bernstein’s code theory to develop an explanatory mechanism for change and stability within the university, which he sees as an “emergent and irreducible social structure.” The combination of Bourdieu and Bernstein has led Maton to develop “Legitimation Code Theory“. In his study of the changing field of high education in England preceding the development of the new cultural studies discipline is what he describes as a struggle of control over the “legitimation device” — the “languages of legitimation” that dominant actors in the higher education field use to control what is allowed / not allowed. The legitimation device controls:

“the ways in which participants represent themselves and the field in their beliefs and practices are understood as embodying claims for knowledge, status, and resources. These languages of legitimation may be explicit (such as claims made when advocating a position) or tacit (routinised or institutionalised practices). All practices (or ‘position-takings’) thereby embody messages as to what should be considered legitimate. I conceptualise these messages as articulating principles of legitimation which set out ways of conceiving the field and thus propose both rulers for participation within its struggles and criteria by which achievement or success should be measured. The ‘settings’ or modalities of these principles of legitimation are regulated by the legitimation device.” 1

The principles governing the legitimation device are Autonomy (structuring of external relationships to the field), Density (relations within the field), Specialization (relations between the social and symbolic or cultural dimensions of the field), and Temporality (temporal aspects of these relations). Each principle can be ‘set’ (+/-) based on the preference of the dominant in field.

“To analyse change in higher education using these concepts is to view higher education as a dynamic field of possibilities. The legitimation device is the means of generating and distributing what is and is not possible within the field. Positions and position-takings are conceived of as representing possibilities, where some possibilities may be recognised, some realised, but others remain latent (unrecognised and unrealised). A possibility exists within a structured system or field of possibilities; conversely, a field is a structured space of possibilities. The structure of a field (and so the range and distribution of possibilities) is given by its legitimation code modality. Changes in legitimation code thereby represent changes in the structuring of the field and so the space of possibilities. To examine the emergence of new possibilities (such as cultural studies) is to analyse the effects of changes in legitimation code on the field.” 2

The legitimation device defines the dominant and dominated legitimation codes that set up the possible positions and their relative power / authority within the field of practice of higher education.

legitimation device and code

The legitimation device describes the set of possible positions in field. PA = positional autonomy; RA = relational autonomy MaD = material density; MoD = moral density SR = social relation; ER = epistemic relation C = classification; F = framing; i = internal; e= external; t = temporal +/- = relatively stronger/weaker

Ok, so lots of very abstract theory-talk here. But, I believe that the legitimation device as an analytic tool could be deployed to systematically study the changes in the field of higher education that have occurred over the past 15 to 20 years that led to the emergence of global health as a field of study. What have been the dominant legitimation principles in the most powerful universities in the U.S.? Who within these universities have controlled the legitimation device? Why? What shifts in the broader external political and economic and internal university (student, staff, faculty) environment have exerted pressures on those in control of the legitimation device?

How could those pressures (perhaps those akin to a social movement??) and the competition over the legitimation device create the space for a new domain of global health studies to emerge on college campuses across the U.S.?

  1.  Maton, Karl. “The Field of Higher Education: A Sociology of Reproduction, Transformation, Change and the Conditions of Emergence for Cultural Studies.” Diss. St. Johns College, U of Cambridge, 2004. p. 83. ↩
  2.  Ibid. p. 84. ↩

‘A Theory of Fields’ and the right to health movement

a theory of fieldsI think that Bourdieu’s concepts of field, capital, and habitus are very important to be able to understand the history and future of the movement for global health equity, as I’ve written about here.  The challenge I was trying to address in that piece was one of insurgent action and the dynamics of change within fields. Bourdieu’s account of fields of social action biases towards stasis — action is inhibited, or at least structured by the cumulative embodiment of history as habitus.

How does social change happen? This is something that Bourdieu is relatively quiet on in his work and is where McAdam and Fligstein have tried to build on the tradition of “field-based” social theory to account for social change in “meso-level social orders.” The result is their 2012 book, “A Theory of Fields” (TOF).

Doug McAdam is a scholar that I’ve drawn inspiration from for at least the last five years and is someone who has loomed large over the sociology of social movements for decades. His political process model serves as a way to conceptualize and study social movement emergence, growth, and decline is a standard for social movement sociology. He started his professional dialogue with Neil Fligstein, an organizational and political sociologist, decades ago and together they have been trying to understand why so many social scientists of different methodological and theoretical angles have come to a similar set of concepts and ways of interpreting social action. As they put it in the preface for TOF:

“We believe the reason that all of these scholars across so many disciplines, subfields, and methodological and theoretical persuasions have come to find one another is because we have all inadvertently discerned a set of foundational truths about social life. The problem of mesolevel social order and the creation of strategic action fields is the central problem of a social science interested in how people engage in collective action, how they construct the opportunity to do so, the skills they bring to the enterprise, how they sometimes succeed, and if they do succeed, how they seek to stabilize and maintain the resulting order. These issues are central to an understanding of how people make political change, build a new product to take to market, challenge existing laws by lobbying governments, as well as how actors maintain a stable hierarchical order in popular music, haute cuisine, or any other cultural field. It is this deep sociological problem that is at the core of what we are writing about. As such, we are happy to acknowledge our interest in and relation to the wide and voluminous literature that has developed on these topics in recent years. We have learned from these various literatures, borrowed from them, and tried to contribute to them. We have returned to this manuscript in order to clarify some of the literatures’ critical insights and to finally consolidate and elaborate the various strands of our own thinking.” 1

It’s kind of amazing to just be stumbling upon this book, especially after having written “Opportunities for research and practice in the social movement for the right to health” which was grappling with this same topic through the lens of global health. It’s also thrilling because I think that it provides an useful theoretical framework to study and actually engage in the social movement building work for the right to health; work that does, in fact, link ideas the ground Bourdieu (field, capital, habitus), McAdam (political process model), and Ganz (leadership and community organizing practice in social movements).

McAdam and Fligstein’s theory of fields rests on three clusters of ideas:

  1. Strategic action fields (SAFs): Meso-level social orders which serve as the basic structural building block of modern political / organizational life in the economy and civil society. This theoretical treatment allows sociologists to study stability and change dynamics at the field-level a la Bourdieu / Wacquant.2
  2. Embeddedness of fields: Fields are embedded within a broader environment of countless other strategic action fields and states (which themselves complex SAFs). Crises and shocks in proximate SAFs are often what create the space and opportunity for change within the SAF under study. SAFs can also be envisioned as if “Russian stacking dolls”: for instance the American economy could be broken down into specific industries, those industries into specific firms, those firms into regional offices / departments / functional units, and those departments into specific teams. Each of these SAF contain actors who make decisions about what to do in relationship to the other actors in the field.
  3. Social skill: Finally, M+F’s theory rests on the a microfoundation of an “existential function of the social.” Explaining social action within fields relies on a complex mix of material concerns (power, resources, constraints, opportunities) and also “existential” considerations: human emotions, meaning making, belonging, relationships. By understanding the essentially existential nature of human existence, M+F introduce the concept of “social skill” and “skilled social actors” who know how to bring people together, form relationships, shape meaning making of collective experience, and enable people to work together for shared social aims. Skilled social actors are necessary to create, maintain, and transform strategic action fields. “Put another way, the concept of social skill highlights the way in which individuals or collective actors possess a highly developed cognitive capacity for reading people and environments, framing lines of action, and mobilizing people in the service of broader conceptions of the world and of themselves.” 3

Overall, I think that this approach has much to offer students of institutions and change within global health. One can imagine the field of global health and international development as a somewhat distinct group of collective actors (NGOs, MOHs, foundations, financing organizations) all operating with a set of governing logics that are to some degree imposed by those dominant within the field of strategic action (aka, the financiers; think Gates, USAID, DFID, etc). More often than not, the logics that are imposed are rooted implicitly or explicitly in neoliberalism. This drives the logic of production of  “the good project” by international NGOs as described by Monika Krause. International NGOs, at the mercy of international financing bodies, must conform their work to producing short term, often vertically oriented global health programs that serve relatively easy to serve populations, outside of the public sector, in order to produce statistically significant outcomes / impact in order to appeal to donors’ grant evaluations and requirements.

This is how neoliberal logic is reproduced within well-meaning NGOs4 that have goals to advance human rights. More work should be done to extend Krause’s work more specifically from international development NGOs to more specifically global health organizations.

Finally, and this is the work that I hope to be able to do formally in graduate school, I believe there is a huge opportunity to study and understand how rights-based delivery organizations (PIH, Last Mile Health, Project Muso, Possible, etc) are making an insurgent response in the face of these orthogonal logics. How do they keep themselves from adopting the dominant logic and conforming with the resource and power flows within the field? What type of collective action, skilled social actors, meaning making processes, social movement organizing activities enable these organizations to insulate themselves from the broader field? How might these organizations continue to invent new modes of collective action that could actually alter the rules of the game and enable resources to flow in ways that support the public sector’s capacity to protect rights of citizens?

  1.  Fligstein, Neil; McAdam, Doug (2012-04-16). A Theory of Fields . Oxford University Press. Kindle Edition. ↩
  2.  Bourdieu, Pierre, and Loi Wacquant. An Invitation to Reflexive Sociology. Chicago: University of Chicago Press, 1992. 36-46. ↩
  3.  Fligstein 2001a; Jasper 2004, 2006; Snow and Benford 1988; Snow, et al. 1986). Fligstein, Neil; McAdam, Doug (2012-04-16). A Theory of Fields (p. 17). Oxford University Press. ↩
  4.  Keshavjee, Salmaan. Blind Spot: How Neoliberalism Infiltrated Global Health. N.p.: n.p., n.d. Print. ↩

Opportunities for research and practice in the social movement for the right to health

The right to health is a contested idea.[i],[ii] Increasingly, people agree that individuals have the right to be free from disproportionate risk of illness and early death.[iii] But, there are wide disagreements about what limits ought to be set around a right to health,[iv],[v] the practical mechanisms to protect the right to health,[vi],[vii],[viii] and what type of social and political strategies should be advanced to dismantle the historically, socially, and politically constructed barriers that limit our progress.[ix],[x],[xi],[xii],[xiii],[xiv] Because the right to health is at the center of a political contest that is historically and socially constructed, we need better theory about the social construction of the field of practice of global health. We also need a deeper understanding of the nature of social movements as sources of reform efforts and the practical organizational models that can grow such movements. This paper seeks to explore a research and organizing agenda that could better elucidate the social processes that underpin social movements and point toward more robust strategies to strengthen the right to health movement. This research and practice agenda should be “historically deep and geographically broad”[xv] and connect a critical study of the sociology of social movements,[xvi],[xvii] organizational theory,[xviii] and the field of practice of international development and global health.[xix],[xx],[xxi]

Social theory is used to contextualize and interpret the complex situations that characterize global health.[xxii],[xxiii] I will briefly share the work of three scholars that are rarely cited by global health practitioners but whose ideas provide a useful toolkit in studying and advancing the social movement for the right to health. I argue that there is a significant opportunity to deploy the social theory of Pierre Bourdieu in critical study of the field of practice of international development and global health, Doug McAdam’s political process model as a way to describe the emergence and growth of social movements, and Marshall Ganz’ community organizing and leadership pedagogy. I will then use these tools to provide a brief analysis of the current moment in the right to health movement and delineate some potential opportunities to strategize about future mobilization. I will also share early experiences in developing a grassroots community organizing strategy through the global health and social justice organization, Partners In Health (PIH). Working to create PIH Engage[xxiv] has helped us to understand how regular, concerned citizens, can work together to demand new modes of solidarity and redistribution from their communities and elected policy makers. Taken together, I hope to renew a discussion about modes of collective action that could continue to dismantle the deeply held double standards that prevent poor and marginalized people from being served by health care delivery systems.

Bourdieu and theory in the right to health movement

Pierre Bourdieu, a giant of 20th century sociology, built a theory of social action based on field research ranging from kinship relationships in isolated villages in Algeria to the social processes of production, circulation, and consumption of art and literature in 19th century France. His work sought to bring “reflexive”[xxv] sociological methods into building a whole understanding of social action: to “uncover the most profoundly buried structures of the various social worlds which constitute the social universe, as well as the ‘mechanisms’ which tend to ensure their reproduction and their transformation.”[xxvi] If the movement for the right to health is a process of social transformation, Bourdieu gives us a way to understand the ‘buried’ mechanisms that could be useful in hastening that transformation. Particularly useful to this understanding, Bourdieu describes three fundamental ideas that govern social action: field, habitus, and capital.

The field of social action is produced and reproduced by individuals and organizations that do not exist in a vacuum. Individuals and organizations exist in relationship to one another as they work in pursuit of shared aims, develop shared taken-for-granteds, grow shared interpretations, and come into competition for scarce resources. Loïc Wacquant offers a succinct definition: “a field is a patterned system of objective forces (much in the manner of a magnetic field), a relational configuration endowed with a specific gravity which it imposes on all objects and agents which enter it… Simultaneously, [it is] a space of conflict and competition, the analogy here being with a battlefield, in which participants vie to establish monopoly over the species of capital effective in it.”[xxvii] This social jostling and competition between actors in the field set up the terrain of a social game that is played out by social actors vying for dominance.

The habitus can be understood as an individual’s patterns of thoughts, behaviors, tastes, and actions acquired by their experienced participation in the social field of action. Bourdieu describes it as: “embodied history, internalized as a second nature and so forgotten as history—the active presence of the whole past of which it is the product.”[xxviii] Wacquant expands, “Cumulative exposure to certain social conditions instills in individuals an ensemble of durable and transposable dispositions that internalize the necessities of the extant social environment, inscribing inside the organism the patterned inertia and constraints of external reality… habitus is creative, inventive, but within the limits of its structures”.[xxix] The field of practice tends to produce individuals who have experienced and internalized the rules of the game as their habitus. Those individuals tend to then act in a way that reproduces the socially constructed field of practice, which, in turn, reinforces the internalized habitus of those in the field.

Finally, Bourdieu conceptualizes capital as multifaceted forms of field-specific power: economic, social, and symbolic. Economic capital is immediately transformable into money, but social capital (social relationships, friendships, partnerships), symbolic capital (prestige, clout), cultural capital (credentials, awards), and other forms of field-specific capital aren’t immediately transformable into financial resources. Non-economic forms of capital can be used to dominate fields of practice that organize society. Bourdieu compares each field to a market in which individuals and collective actors compete for the accumulation of the various forms of capital. In a field of practice, an agent with more capital will be successful over those actors with less capital.[xxx]

Again, Wacquant summarizes: “together, habitus and field designate bundles of relations. A field consists of a set of objective, historical relations between positions anchored in certain forms of power (or capital), while habitus consists of a set of historical relations ‘deposited’ within individual bodies in the form of mental and corporeal schemata of perception, appreciation, and action.”[xxxi] For us to build better theory and strategy for the right to health movement, we will need an effort to better construct an understanding of the field of practice of global heath within the broader field of international development and humanitarian relief.

Monika Krause has an important and penetrating analysis of the field of humanitarian reason and international development.[xxxii] In it, she takes a “Bourdieusian” approach to the description of the field of practice of humanitarian organizations. Organizations in this field, no matter how large, must make decisions about what to do, who to serve, and how best to serve them, in order to make their missions manageable. She describes this field as a set of relationships between large, international NGOs. These NGOs inhabit a shared social space and logic of practice that is governed by the pursuit and production of ideal “good projects”—those that can produce short term, quantifiable effects and serve groups that are relatively easy to assist. Krause argues that, “humanitarian relief is a form of production, transforming some things into other things. Agencies produce relief in the form of relief projects. As the unit of production is the project, managers seek to ‘do good projects.’ The pursuit of the good project develops a logic of its own that shapes the allocation of resources but also the types of activities that we are likely to see—and the type of activities we are not likely to see.”[xxxiii] The logic governing the production of the “good project” is driven by the habitus of “desk officers,” who are responsible for making these decisions and in doing so, practice a process of triage in response to resource constraints. International development financing and bilateral foreign aid programs create a global market of easily comparable “good projects” that are driven by principles of efficiency, cost-effectiveness, sustainability, and short term intervention: principles of neoliberalism.

These principles are generally incompatible with the goal of enabling governments, over the long term, to protect the right to health. The logic of “the good project” serves the practical function of transforming the role of the public sector through competitive contracting to for-profit and nonprofit private actors. The emergence of a global scale of comparison for relief projects drives the “projectification” of the field of global health and international development.[xxxiv]

If we accept Krause’s analysis of the current field of practice of humanitarian relief—one that drives the structured production and financing of narrowly defined good projects—organizations with a different logic might be able to mount an insurgent response. For instance, organizations with the explicit purpose to accompany ministries of health and governments to be effective in delivering on commitments to protect the right to health for their citizens could band together to demand new policies and financing mechanisms that are well suited to those ends.

This understanding may shed light on the ways that the history of neoliberal ideology is reproduced throughout financing, policy, and the organizational practices of international NGOs. It could also provide new insights for the network of organizations and individuals who strive for a different reality: one where the access to high-quality health care services is not a function of one’s ability to pay for them. To build this new reality, we need a social movement. But, first we must understand how social movements come about; especially how they emerge, expand, and decline.

McAdam and the emergence of social movements

Doug McAdam’s political process model is a very useful framework for analyzing social movements. It identifies three sets of factors that are considered to be crucial for the emergence and development of social movements. First, organizational strength—the degree to which an aggrieved population is organized, formally or informally—is an essential component to the successful emergence of a social movement. Second, the collective assessment of political opportunities and chances of success is necessary to build momentum within grassroots organization. Finally, a degree of political alignment between the locally organized insurgent groups and the broader political and socioeconomic environment is necessary to be able to exploit spaces of opportunity for the social movement to expand. These three factors could be thought of as “degree of organizational readiness”, the level of “insurgent consciousness”, and finally the “structure of political opportunities.”[xxxv]

This model for conceptualizing social movement emergence can be visualized like the diagram below. Broad socioeconomic processes create the space (or remove space) and develop expanding (or contracting) political opportunities for insurgent groups to advance their movement. Yet, relying on an overly deterministic and structural set of factors to explain social movement emergence is insufficient to describe the range of movements and insurgency we see in the world. These structural factors enable a certain “structural potential” for political action, but they do not guarantee it. The final factor necessary for the emergence of social movements is the notion of “cognitive liberation”—the capacity for a group to transform their understanding, name their situation as unjust, and have the capacity to imagine an alternative reality that could be transformed together.[xxxvi] This cognitive liberation is a function of leadership, narrative, teamwork, and action.

Figure 1: Political process model for social movement emergence (McAdam, 1982)

Figure 1: Political process model for social movement emergence (McAdam, 1982)

Bourdieu’s notions of field and capital and McAdam’s political process model were brought together in an analysis of the reform process that produced a major shift in global multi-drug tuberculosis (MDRTB) treatment policy in the late 1990’s.[xxxvii] Victor Roy, in his Cambridge University master’s thesis, builds an understanding of the field of social action that led to the WHO’s focus on Directly Observed Therapy Short Course (DOTS)[xxxviii] as the single and only means of tuberculosis (TB) treatment from the 1970’s through the early 1990’s. This treatment regimen categorically excluded attempts to treat people with drug-resistant disease. Roy links this understanding of the field of global TB policy making to reform efforts made by Partners In Health and the organization’s strategy to demonstrate that MDRTB could be treated and cured effectively in poor settings like the slums of Lima, Peru. Leaders of PIH were able to mobilize field-specific scientific and cultural capital that became significant enough to alter the “cognitive cues” of those in the field. Together, they created a new “frame” of cognitive liberation that enabled potential allies and others to understand that the field was increasingly vulnerable to potential change.[xxxix]

The case of reform in MDRTB treatment policy is not, in the full sense, a “social movement”. Although, Roy’s analysis does demonstrate the significant opportunity to utilize the joint tools of Bourdieu and McAdam in studying reform efforts in global health policy, it is important to understand the shortcomings. The global tuberculosis epidemic has not abated and TB recently became the largest infectious disease killer in the world.[xl] Higher prices for key MDRTB drugs, lack of new pooled donor financing mechanisms, and perpetually weak health systems all present significant barriers to making progress in ending TB.[xli] Why has this reform effort been unsuccessful or, at least, incomplete?

Turning back to Bourdieu and McAdam we could understand the gap in terms of the types of capital that were chosen and available to PIH to mobilize their reform effort. The PIH team was able to enter the field of global TB policy making primarily due to their ability to mobilize the symbolic and scientific capital available because of their position within Harvard Medical School. The limited capital available to PIH structured and limited its strategy to focus primarily on technical policy changes—shifting DOTS protocol to DOTS-plus[xlii] and the development of the Green Light Committee at the WHO[xliii]—rather than a more broad-based political strategy. In Bourdieusian terms, the limitation could be understood as a lack of access to political capital that would be necessary to mobilize democratic pressure for larger redistributive financing mechanisms. Similarly, using McAdam’s political process model we would interpret this as a gap in local organizational strength of the reform movement. The PIH experience with TB stands in contrast to the AIDS treatment movement during which large numbers of activist groups were involved in grassroots political mobilization to exert local-level political pressure on key policy makers responsible for U.S. government global AIDS policy-making and funding.[xliv] These two historical examples and the theoretical tools of Bourdieu and McAdam are useful to understand the current moment in the movement for the right to health. But, if strong, local grassroots organizations are an important source of field-specific capital for global health reform, it is important to consider how they are built throughout social movements.

Marshall Ganz, organizing, and social movement leadership

Doug McAdam’s political process model gives us an elegant means of describing the emergence and growth of social movements, but it does not give concrete tools or specific practical guidance for individuals and organizations seeking to advance a particular struggle. Marshall Ganz’ work to build a practical and theoretically deep pedagogy of community organizing gives such a framework. Ganz’ organizing pedagogy enables individuals and organizations to identify, cultivate, and grow the capacities of leaders to advance collective action. Central to Ganz’ view of organizing is a deep notion of social movement leadership:

Leading in social movements requires learning to manage the core tensions at the heart of what theologian Walter Brueggemann calls the “prophetic imagination”: a combination of criticality (experience of the world’s pain) with hope (experience of the world’s possibility), avoiding being numbed by despair or deluded by optimism. A deep desire for change must be coupled with the capacity to make change. Structures must be created that create the space within which growth, creativity, and action can flourish, without slipping into the chaos of structurelessness, and leaders must be recruited, trained, and developed on a scale required to build the relationships, sustain the motivation, do the strategizing, and carry out the action required to achieve success.[xlv]

Successful social movement leadership is not something innate in individuals, it is something that can be learned and purposefully cultivated. Ganz has developed a robust practice of community organizing training[xlvi] that closely links a set of iteratively developed leadership practices. Relationships that are purpose-based and rooted in shared values, built on commitments, and grown from an exchange of resources and interests must be formed. New stories about the potential for a shared future that links values, emotion, and action into a “story of self,” a “story of us,” and a “story of now” must be told. Social movement leaders must develop creative strategies to successfully challenge those with more power by harnessing opportunities that arise due to environmental or context changes. Organizations must create purposeful structure amongst membership and organize time into campaigns for real action that grows power over time. Finally, teams must be developed that enable “snowflake-like” leadership structures and are capable of collaboratively deliberating, making decisions, and holding members accountable.[xlvii]

Moving from theoretical to organizationally pragmatic, Pierre Bourdieu, Doug McAdam, and Marshall Ganz give us an extremely useful set of ideas that should be more systematically deployed by scholars of and practitioners within the movement for the right to health. Bourdieu gives us a way to imagine the field of global health as a collection of actors working to expand their economic, social, and symbolic capital to control the “rules of the game”. The social movement for the right to health is a reform effort that seeks to shift the field away from neoliberal-dominated practice towards the aim of expanding state-protected rights. McAdam gives us a more specific way to view the social movement for the right to health. Using the political process model, we can analyze the structure of political opportunities that characterize the current moment for the right to health movement, the strength of local, grassroots organizations, and opportunities for “cognitive liberation” to imagine new realities of health care delivery in settings of poverty. Finally, Ganz gives a pragmatic model of local community organizing leadership training that civil society, grassroots community groups, and health care delivery oriented NGOs could adopt to grow the local capacities of actors in the struggle for the right to health.

The current moment: the urgent need for a revitalized movement

In certain circles, the current narrative around political opportunities for the right to health movement is pessimistic. In 2012, the Institute for Health Metrics and Evaluation asked if we were nearing the “end of the golden age of global health”.[xlviii] Decrying the weakening of bipartisan leadership in global health and a precipitous decline in the number of direct action activist organizations focused on expanding global AIDS funding,[xlix] it may appear that the movement that spurred the creation of the Presidents Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, TB, and Malaria (The Global Fund) and the corresponding “delivery decade”[l] may be waning. However, four trends ought to give us hope.

First, the rise of universal health coverage (UHC) as a key global goal in the unanimously adopted UN Sustainable Development Goals[li] presents an important opportunity to create more political space for the right to health agenda. While this is an opportunity to demand access to quality health services far more broadly, it is also a contested concept that the right to health movement will need to make claims and build consensus around.[lii] A clear definition of UHC is necessary if we are to avoid the pitfalls of “Health for All” in 1987’s Alma-Ata Declaration which had high level leadership, but lacked sufficient political and budgetary space to realize its aims. It is clear that political will and engagement with civil society will be necessary to promote a rights-based approach and to institutionalize accountability to meet the needs of disadvantaged people.[liii]

A second important expanding political opportunity is the election of Dr. Jim Yong Kim as the president of the World Bank Group in 2012.[liv] Dr. Kim is a long-time right to health activist and his book Dying for Growth: Global Inequality and the Health of the Poor[lv] is a compilation of essays detailing how neoliberal policies deployed by the World Bank have harmed the health of poor and marginalized people and hampered states’ capacity to protect the right to health of their citizens. We should see his appointment as an opportunity to deploy this powerful position to imagine and actually create new financing mechanisms for the expansion of rights-based UHC in low-income countries.

Third, we are in an open U.S. presidential election in which candidates on both sides of the aisle must actively campaign. This presents a significant opportunity for right to health activists to engage with them on the campaign trail at small and mid-sized events in early-primary states. Commitments matter during campaigns (presidential campaigns in particular) when candidates are forced to take specific stances on issues and make pledges to quantifiable targets.[lvi] We have an opportunity to birddog[lvii], a tactic pioneered by AIDS activists, to gain commitments from politicians, many of whom have been significantly supportive of global health efforts in the past.

Finally, the Ebola epidemic in West Africa decimated already beleaguered health systems and killed more than eleven thousand people.[lviii] This has driven significant new discussion by policy makers on the role of U.S government development assistance in strengthening health systems in low-income countries.[lix] This framing—Ebola as a failure of already weak health systems—creates a powerful window for activists in the right to health movement to advance calls for new legislation that could enable new investments in health systems strengthening in poor countries.

With these factors taken into consideration, the structure of political opportunities seems robust. But, what about the “structural potential” of locally organized constituencies and grassroots organizations? Globally, there is a growing network of global health delivery organizations working with a rights-based approach that seek to link delivery of services to accompaniment of the public sector and the generation of new knowledge.[lx],[lxi],[lxii],[lxiii],[lxiv] Additionally, a large network of student driven global health organizations[lxv],[lxvi],[lxvii],[lxviii],[lxix],[lxx],[lxxi] is moving forward and expanding global health academic programs at universities across the U.S.[lxxii],[lxxiii]

Figure 2: Growth of academic global health programs in the U.S. (majors, minors, study abroad programs, centers, and other formal programs dedicated to global health studies)

Figure 2: Growth of academic global health programs in the U.S. (majors, minors, study abroad programs, centers, and other formal programs dedicated to global health studies)

Although many of these student driven global health organizations are primarily service and education oriented, students are increasingly engaged in politics and activism.[lxxiv] Other global health activist networks are also working hard to advance justice-based policies in health.[lxxv],[lxxvi] All told, there seems to be growing “structural potential” in the right to health movement. There are more rights-based delivery organizations, more scholarship and university engagement in global health, and more potential global health justice activists than ever before. This structure can potentially be mobilized and directed toward the immense challenges faced by the right to health movement.

Figure 3: Political process model adapted to model the current moment in the right to health movement

Figure 3: Political process model adapted to model the current moment in the right to health movement

Cognitive liberation—imagining new realities that are not immediately available to our socially constructed notion of reality, our habitus—is necessary to translate this structural potential into action and momentum for the right to health. From demonstrating an effective model for curing MDRTB in Lima, Peru[lxxvii],[lxxviii] to demonstrating that HIV treatment could be scaled in places of extreme poverty like central Haiti,[lxxix] PIH has worked to prove the possible in global health. Roy demonstrates how this proof, which is developed via the accrual of scientific capital, can catalyze policy reforms by altering the balance of power within a field of global health practice. These beacons of hope should serve as an antidote to despair in the midst of a culture that is socialized for scarcity.[lxxx] The future to the right to health movement is dependent on recasting the global health equity narrative towards one of possibility, growing new grassroots organizations that have the capacity to do political work, and creating the policy space for novel financing mechanisms.

PIH Engage: An organizing model in practice

PIH Engage was launched in 2011 with the goal of harnessing the goodwill and enthusiasm for the right to health mission of Partners In Health that has grown during its 25 years of work fighting for global health equity. We are attempting to deploy Marshall Ganz’ model of community organizing—identifying and recruiting volunteer leaders, building community around that leadership, and generating power from that community—as a way to enable regular, concerned citizens, to work together to demand new modes of solidarity and redistribution from their communities and elected policy makers. So far, we have organized more than 90 teams of volunteer community organizers across the U.S. to engage their local communities, organize campaigns that raise funds for health care delivery efforts, and take on direct advocacy campaigns to create new policy space for rights-based financing mechanisms.

By the end of this year, we hope to have raised more than one million dollars from grassroots supporters, gained real commitments from political actors, from U.S. senators and representatives, as well as held demonstrations on dozens of college campuses and cities across the U.S., and moved forward a major new piece of health systems strengthening legislation. This work has a long way to go before it could be characterized as a social movement. And, even if successful, this effort will only be one small component of a much larger trans-national effort. But I believe that our experience so far shows that it has been a worthwhile investment. Hopefully PIH Engage can serve as a model for other rights-based healthcare delivery and advocacy organizations to strategize on how they could grow networks of organizers dedicated to advancing right to health campaigns in their local communities.

There is an opportunity to more systematically build theory and practice in the study of the right to health movement. Pierre Bourdieu gives us a theoretical framework with which to analyze the socially constructed field of practice that mediates and constrains the way organizations and individuals in the right to health struggle engage in the world. Doug McAdam gives us a model of social movement emergence and tools to analyze the structure of political opportunities, organizational strength, and narrative-driven cognitive liberation that can help direct strategic action. Finally, Marshall Ganz gives a concrete community organizing training and organizational framework that can be deployed by organizations to build a more powerful base of grassroots activists. If we take these linked frameworks as useful, we can see our collective work as growing the types of field-specific capital necessary to reorient the “rules of the game”, especially the way in which global health delivery gets financed. This field-specific capital could be grown through a wide variety of tactics: growing fundraising capacity, building the evidence base for effective rights-based delivery efforts, creating new narratives of possibility and beacons of hope, mobilizing the grassroots around this narrative of possibility, and developing grass-tops and grassroots political power capable of implementing new policy and financing mechanisms.

This essay is not meant as a comprehensive analysis of the right to health movement or a full review of the scholarship of social movements, community organizing, and their application to the right to health movement. It is however an attempt to sketch out an opportunity for expanded research and practice directed towards building a better understanding and more robust strategy for the practical effort of advancing a successful right to health movement.

Works Cited:

[i] Barlow, Phillip. “Health Care Is Not a Human Right.” British Medical Journal, 1999, 321.

[ii] Farmer P. Pathologies of power: rethinking health and human rights. American Journal of Public Health. 1999;89(10):1486-1496.

[iii] Universal Declaration of Human Rights (UDHR), G.A. Res. 217A (III) (1948), Art. xxv. Available at http://www.un.org/Overview/rights.html.

[iv] Kingston, Lindsey N, Elizabeth F Cohen, and Christopher P Morley. “Debate: Limitations on Universality: The ‘right to Health’ and the Necessity of Legal Nationality.” BMC International Health and Human Rights: 11.

[v] Boggio, Andrea, Matteo Zignol, Emesto Jaramillo, Paul Nunn, Geneviève Pinet, and Mario Raviglione. “Limitations on Human Rights: Are They Justifiable to Reduce the Burden of TB in the Era of MDR- and XDR-TB?”Health and Human Rights, 2008, 121.

[vi] Kim, Jim Yong, Paul Farmer, and Michael E Porter. “Redefining Global Health-care Delivery.” The Lancet, 2013, 1060-069.

[vii] Frenk, Julio. “The Global Health System: Strengthening National Health Systems as the Next Step for Global Progress.” PLoS Medicine 7, no. 1 (2010).

[viii] Binagwaho, Agnes, Cameron T. Nutt, Vincent Mutabazi, Corine Karema, Sabin Nsanzimana, Michel Gasana, Peter C. Drobac, Michael L. Rich, Parfait Uwaliraye, Jean Nyemazi, Michael R. Murphy, Claire M. Wagner, Andrew Makaka, Hinda Ruton, Gita N. Mody, Danielle R. Zurovcik, Jonathan A. Niconchuk, Cathy Mugeni, Fidele Ngabo, Jean De Dieu Ngirabega, Anita Asiimwe, and Paul E. Farmer. “Shared Learning in an Interconnected World: Innovations to Advance Global Health Equity.” Globalization and Health Global Health, 2013.

[ix] Gostin, Lawrence O. “A Framework Convention on Global Health.” JAMA, 2012.

[x] Forman, Lisa, Gorik Ooms, Audrey Chapman, Eric Friedman, Attiya Waris, Everaldo Lamprea, and Moses Mulumba. “What Could a Strengthened Right to Health Bring to the Post-2015 Health Development Agenda?: Interrogating the Role of the Minimum Core Concept in Advancing Essential Global Health Needs.” BMC International Health and Human Rights, 2013.

[xi] Gamson, Josh. “Silence, Death, and the Invisible Enemy: AIDS Activism and Social Movement “Newness”” Social Problems: 351-67.

[xii] Kapstein, Ethan B., and Joshua W. Busby. Kapstein, Ethan B., and Joshua W. Busby. AIDS Drugs for All: Social Movements and Market Transformations.

[xiii] Keshavjee, Salmaan. Blind Spot: How Neoliberalism Infiltrated Global Health. N.p.: n.p., n.d. Print.

[xiv] Epstein, Steven. Impure Science AIDS, Activism, and the Politics of Knowledge. Berkeley: University of California Press, 1996.

[xv] Farmer, Paul. Pathologies of Power Health, Human Rights, and the New War on the Poor. Berkeley: University of California Press, 2003.

[xvi] McAdam, Doug. Political Process and the Development of Black Insurgency, 1930-1970. Chicago: University of Chicago Press, 1982.

[xvii] Ganz, Marshall. “Leading Change Leadership, Organization, and Social Movements.” Handbook of Leadership Theory and Practice: An HBS Centennial Colloquium on Advancing Leadership. Boston: Harvard Business, 2010.

[xviii] Davis, Gerald F. Social Movements and Organization Theory. New York, N.Y.: Cambridge University Press, 2005.

[xix] Krause, Monika. The Good Project: Humanitarian Relief NGOs and the Fragmentation of Reason. The University of Chicago Press, 2014.

[xx] Viterna, Jocelyn, and Cassandra Robertson. “New Directions for the Sociology of Development.” Annual Review of Sociology, 2015.

[xxi] Roy, Victor. “The Politics of Reform in Global Health Policy: The Case of Multi-Drug Resistant Tuberculosis, 1991-2001.” Dissertation for University of Cambridge, 2010.

[xxii] Kleinman, Arthur. “Four Social Theories for Global Health.” The Lancet, 2010, 1518-519.

[xxiii] Farmer, Paul. “Unpacking Global Health: Theory and Critique.” In Reimagining Global Health an Introduction. Berkeley: University of California Press, 2013.

[xxiv] “PIH Engage.” PIH Engage. Accessed December 6, 2015. http://engage.pih.org/.

[xxv] Bourdieu, Pierre, and Loi Wacquant. An Invitation to Reflexive Sociology. Chicago: University of Chicago Press, 1992. 36-46.

[xxvi] Ibid., 7.

[xxvii] Ibid., 17.

[xxviii] Bourdieu, Pierre. The Logic of Practice. Stanford, CA: Stanford University Press, 1990. 56.

[xxix] Bourdieu, Pierre, and Loi Wacquant. An Invitation to Reflexive Sociology. Chicago: University of Chicago Press, 1992. 13-19.

[xxx] Ibid., 18.

[xxxi] Ibid., 16.

[xxxii] Krause, Monika. The Good Project: Humanitarian Relief NGOs and the Fragmentation of Reason. The University of Chicago Press, 2014.

[xxxiii] Ibid., 37

[xxxiv] Biehl, Joao. “Therapeutic Clientship: Belonging in Unganda’s Projectified Landscape of AIDS Care.” In When People Come First Critical Studies in Global Health. Princeton: Princeton University Press, 2013.

[xxxv] McAdam, Doug. Political Process and the Development of Black Insurgency, 1930-1970. Chicago: University of Chicago Press, 1982. 40-51.

[xxxvi] Ibid., 35.

[xxxvii] Roy, Victor. “The Politics of Reform in Global Health Policy: The Case of Multi-Drug Resistant Tuberculosis, 1991-2001.” Dissertation for University of Cambridge, 2010.

[xxxviii] World Health Organization (1998). Basis for the development of an evidence based case management strategy for MDR-TB within WHO’s DOTS strategy. Geneva: WHO, accessed at “World Health Organization & Library Information Networks for Knowledge Database (WHOLIS).” Web. March-May 2010.

[xxxix] Roy, Victor. “The Politics of Reform in Global Health Policy: The Case of Multi-Drug Resistant Tuberculosis, 1991-2001.” Dissertation for University of Cambridge, 2010.

[xl] World Health Organization (2015). World Tuberculosis Report (20th Edition). Retrieved from: http://apps.who.int/iris/bitstream/10665/191102/1/9789241565059_eng.pdf?ua=1

[xli] Hwang, Thomas J., and Salmaan Keshavjee. “Global Financing and Long-Term Technical Assistance for Multidrug-Resistant Tuberculosis: Scaling Up Access to Treatment.” PLoS Medicine 11.9 (2014): e1001738. PMC. Web. 6 Dec. 2015.

[xlii] Farmer, Paul. “DOTS and DOTS-Plus. Not the Only Answer.” Annals of the New York Academy of Sciences: 165-84.

[xliii] Gupta, Rajesh, Alexander Irwin, Mario Raviglione, and Jim Kim. “Scaling-up Treatment for HIV/AIDS: Lessons Learned from Multidrug-resistant Tuberculosis.” The Lancet 363 (2004): 320-24.

[xliv] “The Troubled Path to HIV/AIDS Universal Treatment Access: Snatching Defeat from the Jaws of Victory?” In Global HIV/AIDS Politics, Policy and Activism: Persistent Challenges and Emerging Issues, edited by Raymond A. Smith, by Patricia Siplon. Praeger, 2013.

[xlv] Ganz, Marshall. “Leading Change Leadership, Organization, and Social Movements.” Handbook of Leadership Theory and Practice: An HBS Centennial Colloquium on Advancing Leadership. Boston: Harvard Business, 2010.

[xlvi] Ganz, Marshall. Marshall Ganz Teaching Comments. Accessed December 6, 2015. http://marshallganz.com/teachings/.

[xlvii] Ganz, Marshall. “Leading Change Leadership, Organization, and Social Movements.” Handbook of Leadership Theory and Practice: An HBS Centennial Colloquium on Advancing Leadership. Boston: Harvard Business, 2010.

[xlviii] Institute for Health Metrics and Evaluation. “Financing Global Health 2012: The End of the Golden Age?” Seattle, WA: IHME, 2012.

[xlix] Morrison, J. Stephen. “The End of the Golden Era of Global Health?” Editorial. Center for Strategic and International Studies. Web. <http://csis.org/files/publication/120417_gf_morrison.pdf>.

[l] Farmer, Paul E. “Chronic Infectious Disease and the Future of Health Care Delivery.” New England Journal of Medicine, 2013, 2424-436.

[li] “Goal 3.8 in the UN Sustainable Development Goals.” Sustainable Development Knowledge Platform. Accessed December 6, 2015. https://sustainabledevelopment.un.org/topics.

[lii] O’Connell, Thomas, Kumanan Rasanathan, and Mickey Chopra. “What Does Universal Health Coverage Mean?” The Lancet: 277-79.

[liii] Ibid.

[liv] Garrett, Laurie. “Dr. Kim and the World Bank’s Health Role.” Council on Foreign Relations. April 13, 2012. Accessed December 6, 2015. <http://www.cfr.org/international-organizations-and-alliances/dr-kim-world-banks-health-role/p27952>.

[lv] Kim, Jim Yong. Dying for Growth: Global Inequality and the Health of the Poor. Monroe, ME.: Common Courage Press, 2000.

[lvi] Nelson, Libby. “Campaign Promises Matter.” Vox. November 27, 2015. Accessed December 9, 2015. http://www.vox.com/2015/11/27/9801800/politicians-keep-campaign-promises.

[lvii] Davis, Paul. “Five Questions For: ‘Take the Money Out’ Activist Paul Davis about Disrupting a National Journal Event.” Interview by David Ferguson. Raw Story 6 Sept. 2012. Accessed October 30, 2015. <http://www.rawstory.com/2012/09/five-questions-for-take-the-money-out-activist-paul-davis-about-disrupting-a-national-journal-event/>.

[lviii] “2014 Ebola Outbreak in West Africa – Case Counts.” Centers for Disease Control and Prevention. December 4, 2015. Accessed December 6, 2015. http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html.

[lix] “United States Senate Committee on Foreign Relations.” Hearing. Accessed December 6, 2015. http://www.foreign.senate.gov/hearings/the-ebola-epidemic-the-keys-to-success-for-the-international-response.

[lx] “We Have Everything We Need to End Child Mortality Now.” Muso. Accessed December 6, 2015. http://www.projectmuso.org/.

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