Elsevier

Geoforum

Volume 106, November 2019, Pages 223-233
Geoforum

Biopolitics of public health and immigration in times of crisis: The malaria epidemic in Greece (2009–2014)

https://doi.org/10.1016/j.geoforum.2019.08.019Get rights and content

Highlights

  • Immigrant workers were the mostly hit and most vulnerable group in the malaria outbreak in Greece (2009–2014).

  • This was primarily due to their socio-economic exclusion, labor conditions and exploitation.

  • The disease’s spread was also a result of racist public health biopolitics.

  • Portraying migrants as a risk for public health was capitalized politically during crisis.

  • The stigmatization of migrants as malaria importers disallowed the disease’s timely control.

Abstract

That crisis and austerity have a negative effect on public health is well documented. Less attention has been paid on the explosive combination of crisis with xenophobia and the ways racist policies and discourses produce vulnerable bodies, blamed then for their own disease. We study here the 2009 outbreak of malaria in the Evrotas region of Peloponnese, first time since the official eradication of the disease in Greece in 1974. We find that a crucial factor for the outbreak was discrimination against undocumented farm workers excluded from channels of support maintained for Greek citizens. Like Agamben’s homo sacer, the state sustains immigrant workers at a threshold of existence, initially invisible then turned into biopolitical targets, scapegoats in a public health emergency. Disease such as malaria is the result of interacting human and non-human ecologies produced in a web of power relations. As such, it can be used symbolically and with political purposes in order to enhance xenophobia and “Othering”. Racism, social vulnerability and disease, we claim, can be mutually reinforcing phenomena particularly during times of socio-economic crisis and austerity.

Introduction

In 2009, malaria – a disease officially eradicated in 1974 – re-appeared in Greece with 51 reported cases, seven of which transmitted within the country’s borders, in a small agricultural River Delta of Southern Peloponnese. In 2011, domestic cases climbed up to 42, ringing the alarm of an epidemic. International media reported on malaria’s “comeback” in Greece, relating it to austerity cuts (Henley, 2012). In GDP terms, the post-2009 economic depression in Greece has been the greatest ever faced by a developed Western economy, the U.S. Great Depression including. The severity of austerity policies was unlike anything seen in the EU. Spending on health fell by 25.2% (€4 billion) between the years 2009–2012 (Maresso et al., 2015) and some spoke of a “health tragedy” (Kentikelenis et al., 2011), with soaring mental health problems and epidemics such as influenza A (H1N1) and West Nile Virus (Simou and Koutsogeorgou, 2014).

Although the full range of health impacts in the post-2008 period in Europe remains unknown, we know from other crises that people’s heath suffers greatly from austerity policies and the reduction of public health expenditures. Direct relations have been noted between public health deterioration and neoliberal adjustments and policies dictated by the International Monetary Fund (IMF) (Stuckler and Basu, 2009, Williams and Maruthappu, 2013). Budgetary cuts restrict access to healthcare, affecting both prevention and cure (Brand et al., 2013, Kentikelenis and Papanicolas, 2011). Suicide rates and communicable diseases such as HIV increase in countries implementing austerity policies (Karanikolos et al., 2013, Reeves et al., 2012). And there has been evidence that crisis increases health inequalities in terms of mortality (Maynou et al., 2016). As we show in this article, a politics of blame and xenophobia employed during the malaria epidemic in Greece distracted from and even reinforced the dire effects of austerity on health. It also served political interests by capitalizing on existing and emerging anti-immigration feelings.

Certainly, malaria in Greece re-appeared in a context of crisis and austerity during which vulnerable groups, such as immigrants, suffer the most (Agudelo-Suárez et al., 2013, Chen et al., 2012, Kentikelenis et al., 2015). Crisis alone, however, cannot explain the course of the epidemic. A key aspect in this story was that malaria could be transported, dormant and invisible. And that the vulnerable bodies of immigrant workers, some of them coming from malaria-endemic countries, were situated in mosquito-prone environments. Both the nature of the disease and the (imagined, constructed or real) risk embodied by these workers played a role in how the epidemic was understood and acted upon. As we claim, if malaria would have appeared in a context of austerity but without historically engrained xenophobia, immigrants’ exploitation and blame assigned to them for the disease, the first cases of malaria could have been better controlled and perhaps the epidemic avoided.

Our hypothesis is that framing immigrants as a source of malaria is part and parcel of the conditions of vulnerability that made them more susceptible to it in the first place. We approach disease as the result of interacting human and non-human entities in a web of power relations that are both materially produced and socially constructed. For this purpose, we bring together theory from political ecology and critical public health, as well as the wider social constructivist field. We ask three inter-related questions: what socio-economic and environmental factors rendered immigrants in Evrotas most vulnerable to malaria and how do these factors relate to austerity politics? What types of politics were applied in the name of public health and how did they sustain and reproduce racism and xenophobia? How did this, in turn, affect the spread and control of malaria in the region?

We detect disease-driving factors in socio-ecological interactions within historically contested and constructed natures (King, 2015, p. 347). Natures here include human bodies, agricultural fields, water canals, mosquitoes and malaria parasites. We further illustrate the creation of health narratives and health subjects through the use of biopolitics, as elaborated by Michel Foucault (Foucault et al., 1997) and Giorgio Agamben (1998), to show how and why the “letting die”/“making live” of immigrants shaped their health vulnerability. We point to a familiar pattern of marginalized people’s responsibilization in order to justify state failures (Kotsila, 2017). Crucially, the biopolitical lens applied through a political-ecological framework helps us expose how discriminatory and stigmatizing biopolitics of public health go against the welfare interests they claim to protect. We argue that defending immigrants’ rights and support by the state, even in times of fiscal crisis, would be more productive of good health and well-being, for all.

The following section delineates our theoretical approach and Section 3 describes the methodology. 4 Breeding an epidemic: mosquitoes, Plasmodium, immigrants and institutions, 5 From invisibility to control and stigma: The biopolitical racism of malaria control give a detailed account of the malaria epidemic, presenting the socio-economic and political drivers of the disease (Section 4) and the biopolitics employed for its control and their consequences on the spread of disease (Section 5). Section 6 discusses the dual biopolitics at work and how they link austerity and border politics to public health and health vulnerabilities in Greece. Section 7 offers some concluding remarks.

Section snippets

Biopolitics and the power of discourse in political ecologies of health

Paying attention to the uneven distribution of health-impairing factors at the intersection of socio-cultural and environmental change, political ecologists have offered new explanations of disease. They show how marginalization, dispossession and power/knowledge imbalances relate to health problems like cancer (Armiero and D’Alisa, 2012, Nyantakyi-Frimpong et al., 2016), alcoholism (Singer et al., 1992), or infectious disease transmission (Parizeau, 2015). Political ecology locates individual

Methodology

Our research consists of empirical and secondary data collected between January and August 2015 a year after the outbreak ended (see Fig. 1). We conducted 23 in-depth interviews with public health authorities and practitioners (7), local government representatives (4), health NGOs (2), civil society groups (3), malaria and mosquito experts (5), and immigrant workers (8). In August 2015 we observed public health screenings and interventions by public health officials for three weeks, visiting 13

Breeding an epidemic: mosquitoes, Plasmodium, immigrants and institutions

The malaria epidemic (2009–2014) in Greece appeared in the agricultural plain of the Evrotas River Delta, in southeast Peloponnese. And it affected immigrant land workers the most. Skala, the central town is part of a marshy ecosystem, about 7 km from the coast. Local ecology has historically been one of the most welcoming for mosquito populations (Anopheles type) that transmit the Plasmodium parasite which causes malaria to humans, and can also get it from them. While Anopheles mosquitos are

Biopolitical racism as public health politics in the context of crisis

Presenting immigrants as a public health risk was politically expedient for the ruling coalition of conservatives and social democrats in power at the time. The two parties had governed Greece since 1974 and the end of dictatorship. In the minds of most people they were responsible for the crisis. Allowing part of the blame for the countrýs ills to shift to immigrants was convenient, and drawing attention away from the failure of the state mechanism in even simple things, such as the

Discussion

A core contribution of this research is its integrated analysis of complex public health and immigration questions that combines discursive, political economic and ecological elements of an epidemic in the wider health crisis. Granted, there is considerable literature in each of these fields separately, but few studies bring the three together and show how they inter-relate to produce vulnerable people and epidemics. Our approach, importantly, provides a way out of the dilemma of either making

Conclusions

That xenophobia becomes more intense in times of crisis is something that the whole world is currently witnessing. In our case of malaria, xenophobia served and was mobilized by political interests: diverting attention from the government’s own failures to control mosquitoes and of the dire effects of austerity cuts on preventive health, while also capitalizing on a diffused popular desire of finding someone to blame for the country’s downturn. Unlike in Argentina in the 1900s (Carter, 2012),

Acknowledgments

This work was supported by the European Union’s Seventh Framework Programme for research, technological development and demonstration (Marie Curie Actions) [grant agreement no. 289374 (“ENTITLE”)] and from the “María de Maeztu” Unit of Excellence (MDM-2015-0552) grant from the Spanish Ministry of Economy and Competitiveness.

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