Abstract
The central tension examined in this thesis concerns the liminal space the South African tuberculosis (TB) epidemic occupies in terms of the public health and policy discourses surrounding it. The generalised TB epidemic is framed as an inevitable normality in the lives of Black and Coloured South Africans. On the other hand, the emergence of extensively drug-resistant-TB at Tugela Ferry in 2006 was constructed as a moment of exceptionality, centred around fears of the global health security threat that this resistant strain could pose. This tension invites critical analysis into what constitutes normalcy and exceptionality respectively in terms of the South African TB epidemic. No study has broached this area of enquiry in terms of ‘studying up’, that is, focusing on the discourses around TB from a public health and policy perspective. As a result, novel research questions about the South African TB epidemic emerge: in what ways has South Africa’s colonial-apartheid context shaped contemporary public health policy discourses around TB? And do these discourses differ from the way extensively drug-resistant TB is framed as a threat? Do any ethical implications emerge from a focus on public health and policy discourses about TB in South Africa?These questions are addressed through an interdisciplinary, mixed-methods qualitative approach by examining public health and policy discourse about the South African TB epidemic. Discourse is analysed from a varied data corpus; including semi-structured interviews with TB experts, policy documents from the WHO, the Stop TB Partnership and the South African National Department of Health, and news media articles about the tuberculosis epidemic in South Africa. The various empirical, conceptual, and moral insights arising from this research were only possible by taking an integrative interdisciplinary approach, combining key concepts from security studies, methodology and methods from sociology and a conceptual framework from postcolonial studies.
Ultimately, this thesis argues that the ongoing coloniality of the South African colonial-apartheid context underpins both the discourse of TB as a normal part of South African society, and the contrasting discourse around the emergence of XDR-TB as an exceptional threat. That is, South Africa’s colonial-apartheid context has shaped public health and policy discourses about TB (as a ‘slow’, ‘old’ and ‘curable’ disease) such that the epidemic is framed as the social embodiment of this durable colonial-apartheid context. The way in which the generalised TB epidemic is represented as quotidian in South Africa, in turn, sheds light on the indirect, yet significant ways in which security logics maintain a violent state of normalcy for Black and Coloured bodies. It is precisely because the emergence of XDR-TB excites post-colonial fears that it was responded to as a health security threat. That is, in framing XDR-TB as a moment of exceptionality, the violent normal politics of a racialised, general TB epidemic is preserved.
As a novel empirical contribution, this research about the South African TB epidemic highlights how health security and coloniality are deeply intertwined, and how race and relations of force permeate both concepts of ‘normalcy’ and ‘exceptionality’. The key ethical implication from this finding is that ethical obligations concerning the care and prevention of TB are similarly structured by race and relations of force. As such, to develop an ethical response to the ‘normalcy’ of the South African TB epidemic, an ethical response towards coloniality is needed. Such a response requires an acknowledgement of the ‘colonial global’, and is necessarily reparative, both epistemologically and materially.
| Date of Award | 1 Apr 2023 |
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| Original language | English |
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| Supervisor | Anne Pollock (Supervisor), Lara Fairall (Supervisor) & Mark Eccleston-Turner (Supervisor) |