Lancaster Kari, Rhodes Tim, Rance Jake
Centre for Social Research in Health, UNSW Sydney, Australia.
Centre for Social Research in Health, UNSW Sydney, Australia; London School of Hygiene and Tropical Medicine, UK.
Int J Drug Policy. 2020 Jun;80:102419. doi: 10.1016/j.drugpo.2019.02.008. Epub 2019 Apr 8.
In 2016 the World Health Organization published the first global health strategy to address viral hepatitis, setting a goal of eliminating viral hepatitis as a major public health threat by 2030. While the field has been motivated by this goal, to date there has been little critical attention paid to the productive capacity and constitutive effects of this policy. How is governing taking place through the mechanism of this global strategy, and how are its goals and targets shaping what is made thinkable (indeed, what is made as the real) about hepatitis C and its elimination? And with what effects? Taking the Global Health Sector Strategy on Viral Hepatitis, 2016-2021 as a text for analysis, we draw on poststructural thinking on problematisation and governmental technologies to examine how 'elimination' - as a proposal - constitutes the problem of hepatitis C. We critically consider the conceptual logics underpinning the elimination goal and targets, and the multiple material-discursive effects of this policy. We examine how governing takes place through numbers, by analysing 'target-setting' (and its accompanying practices of management, quantification and surveillance) as governmental technologies. We consider how the goal of elimination makes viral hepatitis visible and amenable to structuring, action and global management. Central to making viral hepatitis visible and manageable is quantification. Viral hepatitis is made as a problem requiring urgent global health management not through the representation of its effects on bodies or situated communities but rather through centralising inscription practices and comparison of estimated rates. It is important to remain alert to the multiple makings of hepatitis C and draw attention to effects which might be obscured due to a primary focus on quantification and management. To do so is to recognise the ontopolitical effects of governmental technologies, especially for communities 'targeted' by these strategies (including people who inject drugs).
2016年，世界卫生组织发布了首份应对病毒性肝炎的全球卫生战略，设定了到2030年消除病毒性肝炎这一重大公共卫生威胁的目标。尽管该领域受此目标激励，但迄今为止，很少有人对这一政策的生产能力和构成性影响给予批判性关注。治理是如何通过这一全球战略机制进行的？其目标又是如何塑造关于丙型肝炎及其消除的可思考内容（实际上，是塑造被视为真实的内容）的？会产生什么影响？以《2016 - 2021年全球卫生部门病毒性肝炎战略》为分析文本，我们借鉴关于问题化和治理技术的后结构主义思想，来审视“消除”——作为一项提议——如何构成丙型肝炎问题。我们批判性地思考支撑消除目标的概念逻辑，以及该政策的多重物质 - 话语效应。我们通过分析“目标设定”（及其伴随的管理、量化和监测实践）作为治理技术，来研究治理是如何通过数字进行的。我们思考消除目标如何使病毒性肝炎变得可见，并便于进行结构化、行动和全球管理。使病毒性肝炎变得可见且易于管理的核心是量化。病毒性肝炎成为一个需要全球紧急卫生管理的问题，不是通过其对身体或特定社区影响的呈现，而是通过集中记录实践和估计发病率的比较。重要的是要对丙型肝炎的多重形成保持警惕，并关注那些可能因主要关注量化和管理而被掩盖的影响。这样做就是要认识到治理技术的本体政治效应，尤其是对这些战略“目标”社区（包括注射吸毒者）而言。
