Governing Health

There are longstanding legal attempts by the British government to regulate FGC, first in colonial settings and later in racialized groups within the UK. In 2015, the country introduced the Mandatory Reporting Duty: a statutory reporting duty for healthcare professionals to report directly to the police when they have reasonable suspicion of FGC in under 18-year-olds. Here, I will draw on the concept of narrative in public health to set the stage for the development of this clinical obligation. First, I will argue that while the law has been introduced as a safeguarding measure, it came about amid growing concerns that, despite legislation being in place for almost three decades, there had been no successful prosecutions. Second, I will use narrative scholarship to explain that despite broad agreement regarding the lack of successful convictions, the introduction of the statutory duty was not inevitable. Those who adhere to what I have termed the cultural change narrative build on research that suggests widespread cultural change in migrant populations. Proponents argue that a lack of convictions is logical given the reduced, if not largely absent, continuation of the practice. As a result, they urge that the misconceptions about prevalence lead to a disproportionate amount of resources being dedicated to identifying cases of cutting. The more dominant narrative, however, construes the lack of criminal convictions as a failure on the part of law enforcement bodies. Within this second hidden crime narrative, the practice is believed to be hidden, outside of the view of the police, but nevertheless taking place. Increasingly, successful legal convictions are viewed as essential to combating the practice. The prominence of this narrative has resulted in increased detection efforts; a prime example being the Mandatory Reporting Duty.

This article focuses on the "unintended uses" of mental health services by Arab refugees who were resettled into a third destination, New Zealand. Mental health services constitute an integral part of any global humanitarian aid involving refugees during and in post-crisis situations. Based on one year of ethnographic research, I highlight how, in a post-resettlement context, the utilisation of mental health services is differently rendered. It was found that Arab refugees (re)proposed mental health access to voice their resettlement practical needs. Such a phenomenon should be interpreted within the broader psycho-politics of New Zealand, which reinforces the response to mental health issues across social services in advancing the general population’s wellbeing, as a national priority. The article contributes to growing ethnographic research on global mental health.

We explored the possible relationship between colonial-era public health legislation and contemporary pandemic preparedness in former British colonies. Starting from the observation that India, Pakistan, and Bangladesh entered the COVID-19 pandemic with legislation rooted in the 1897 Epidemic Diseases Act, we investigated whether the timing of legislative updates was linked with pandemic outcomes. While initial patterns suggest that earlier updates to law may be associated with fewer deaths, this hypothesis remains tentative and invites further investigation. We extended our scope to a broader set of former British colonies that covered a wider geographic span and multiple time periods and traced the genealogy of infectious disease laws. We noted that legislative reform often follows major outbreaks. Surprisingly, influenza—despite its historical impact—is rarely mentioned in these laws, raising questions about how institutional memory shapes preparedness. We also reflected on the limited integration of international frameworks such as the International Health Regulations into national legislation, and the persistence of colonial legal structures. Rather than offering definitive answers, this work aims to open a conversation about how legal heritage, timing of reform, and global health governance intersect. Future research could benefit from including non-British colonies and examining the role of legal systems more broadly in shaping pandemic response capacity.

Drawing from ethnographic research in Oxford, UK, this paper argues that the Oxford Refugee Health Initiative (ORHI) shapes the clinical gaze of aspiring physicians studying medicine at the University of Oxford by simultaneously promoting critical engagement with the social determinants of health of asylum seekers while promoting an antipolitics of care that upholds the strictures of the UK immigration system. The Oxford Refugee Health Initiative (ORHI) engages medical students at the University of Oxford with the clinical and social care of local asylum seekers and refugees. I consider how medical students working with the ORHI are trained to perceive the health outcomes and needs of asylum seekers. First, I employ Michel Foucault’s framework of the “clinical gaze” to consider how the ORHI educates medical students, paralleling Seth Holmes in applying this framework to clinical approaches to migrant health. I find that the ORHI trains an “ORHI gaze” that considers social determinants of health as an explanation of health outcomes; accordingly, through social prescribing, ORHI students facilitate the social and political life of the asylum seeker. However, this training ultimately serves to reinforce the clinician’s role in upholding the processes and institutions of the UK asylum system by legitimizing state framings of migration, and the resultant management of the asylum seeker population, as an apolitical and decontextualized question. Ultimately, the framings of the ORHI medical education reveals the discomforting paradox of the role of the healthcare provider in the management and care of asylum seekers in the UK: being a doctor risks perpetuating the systems that harm one’s patients. This research is based on interviews with students who have participated in ORHI trainings as well as academic faculty and clinical staff who have conceptualized and enacted the group’s medical education practices. Broadly, this paper demonstrates that medical anthropology can provide clarifying insight into the interplay between immigration regimes and clinical decision-making, an urgent amidst a global rollback of immigrant rights in the 21st century. I conclude with a discussion of the contemporary salience of this line of inquiry for medical anthropologists engaged with the political economy of health and the relevance of medical anthropological inquiry in contemporary life.